Is a Lidocaine Infusion Effective in Treating CRPS / RSD


Chronic pain that comes from RSD or CRPS can interfere with your life, to the point that you can’t participate in work or enjoyable activities. Fortunately, researchers and doctors have found several therapies and remedies that can help you to return to a relatively pain-free state, allowing you to enjoy your life once more.

Lidocaine is an anesthetic that helps to block the pain sensation. You’ve probably received an injection before undergoing dental work or getting stitches for an injury. It worked so well that you were not able to feel the work being done to your tooth or skin. In the same way, lidocaine, in an intravenous infusion, can help to treat the pain you experience. Your pain might originate from phantom pain after a limb amputation, diabetic neuropathy or post-herpetic neuralgia.

Can a Lidocaine Infusion Help

Blue Cross of Idaho descripbes a lidocaine intravenous infusion as “one or more courses of IV infusion . . .  administered over a period of several hours or several days.” (See Blue Cross Idaho) Your doctor or pain specialist are the best medical professionals to decide if this therapeutic approach might be helpful for your pain condition.

A therapeutic lidocaine infusion works by desensitizing the pain pathways in both the central and peripheral nervous systems. Doctors have relied on sympathetic ganglion blocks with lidocaine for years as they treat chronic pain conditions such as RSD or CRPS. Treating chronic pain using this approach is different from using a continuous subcutaneous or an IV infusion.

Your pain specialist may choose to give you an intravenous anesthetic medication using a sub-anesthetic dosage after giving you a bolus injection, or a large dose, of lidocaine to bring the concentration of the drug in your bloodstream higher. Once he has achieved this effect, the sub-anesthetic doses help to maintain a constant level of medication in your body, thus relieving your pain.

Patients who receive a lidocaine infusion can experience a significant level of pain relief – in the RSD Alert website, one patient reports a 70 percent reduction in pain in about two months of treatment. (See RSD Alert website) Because of RSD in the left arm now moving into the left back, this patient has experienced “severe” flare ups of pain related to weather changes, such as wind speed and humidity, she has been prescribed lidocaine patches. Her doctor helps her position the patch so she receives the most optiomal effects on her RSD symptoms. She prefers the lidocaine treatment over her previous medications, which made her nauseated and affected her ability to think and function. She does have to combine the patches with her oral medications, and is now able to function more normally.

Your doctor may use a sympathetic block to stop the sympathetic nerve impulses from reaching the limb that is affected by RSD. When they choose to use lidocaine, it can affect your skin by causing flushing, warming your skin and preventing your limb from sweating. You’ll know that the sympathetic block has been successful when your pain symptoms begin to go away after half an hour. Your doctor knows the block is successful when you develop what is called the ipsilateral Horner Syndrome. Once the pain impulses have been blocked, you can begin physical therapy. The interruption of pain will last for only a few hours, but the positive benefits may last for much longer – as much as several days, writes the Medscape website. (See Medscape website) When you begin, you can anticipate undergoing one to two blocks per week, for an average of four to five blocks total before you receive permanent relief.

Precautions

If you and your doctor decide that a lidocaine infusion could be an appropriate therapeutic treatment, you do need to be watchful of several adverse effects. These include:

– Sleepiness

– General fatigue

– Dizziness

– Respiratory depression

– Tinnitus

– Muscle twitching

– Headache

– Periorbital and limb numbness and tingling

– Nausea and vomiting

– Tremors

– Blood pressure and pulse changes

Severe adverse effects might include:

– Arrythmias

– Psychosis

– Seizures

– Loss of consciousness

– Confusion

– Death

For this reason, your doctor will want to make sure that you have a normal conduction on an ECG; you should also have normal serum electrolyte concentrations in your blood so you don’t run the risk of cardiac arrhythmias. If you have been diagnosed with a heart condition, your doctor will let you know that you might not be a good candidate for a lidocaine infusion – it can slow your heart rhythm.

For the patient with RSD who experienced a 70 percent reduction in pain symptoms, her side effects were a barely noticeable headache and slight nausea. She experienced more of a need to sleep.

Not all patients will respond to therapeutic lidocaine infusion. Because RSD is an unpredictable condition and controlled treatment trials are few in number, therapy and treatment relies on the doctor’s specialty.  Especially when the origin of RSD in the individual patient is not known,  doctors may not know if lidocaine infusion will work – all they can do is try the treatment. Early treatment is critical and must be started before you have reached what is called the “chronic fibrotic” stage.  The severity of your condition can be controlled and reduced with early prophylactic therapies, including immediate and aggressive movement of the affected limb, using passive, then active range-of-motion physical therapy.

https://www.bcidaho.com/providers/medical_policies/pd/mp_50116.asp Blue Cross of Idaho: Intravenous Anesthetics for the Treatment of Chronic Pain
http://www.rsdalert.co.uk/drugs/Lidocaine.htm  RSD Alert: Lidocaine
http://emedicine.medscape.com/article/334377-treatment  Medscape: Reflex Sympathetic Dystrophy Treatment & Management

Mara Gerke