485: Intravenous lidocaine for chronic neuropathic pain: a systematic review and meta-analysis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Pharmacological treatments, Treatment/management

Background and Aims: Intravenous lidocaine is increasingly used for the management of chronic neuropathic pain. Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms of intravenous lidocaine for chronic neuropathic pain. We conducted a systematic review and meta-analysis to summarize the evidence for using intravenous lidocaine in the treatment of chronic neuropathic pain and the risk of associated adverse events.

Methods: We searched seven databases from inception to December 2025 for randomized clinical trials (RCTs) comparing intravenous lidocaine with placebo or active control in adults (≥18 years) with chronic neuropathic pain. We performed random-effects meta-analyses for patient-important outcomes at 3, 24, and 72 hours and 1 and 3 weeks post-infusion, conducted a priori subgroup analyses to explore heterogeneity, and assessed certainty of evidence using GRADE. Primary outcomes were pain intensity (score range, 0–100 mm on a visual analogue scale [VAS]; lower is better; the minimally important difference [MID] is 10 mm) and incidence of adverse events.

Results: Twenty-six RCTs (759 participants) were included. Compared with placebo, moderate- to high-certainty evidence showed intravenous lidocaine resulted in an important reduction in pain at 3 hours (weighted mean difference [WMD] −10.7 mm [CI −15.3 to −6.2]) and 24 hours (WMD −15.2 mm [−22.6 to −7.9]) on a 100-mm VAS, exceeding the MID. Low-certainty evidence suggested small reductions in pain from 72 hours to 3 weeks. Effects were greater in central versus peripheral neuropathic pain and with higher doses (interaction P<0.001). Moderate-certainty evidence showed increased risk of transient lightheadedness, drowsiness, nausea, and perioral numbness.

Conclusions: Intravenous lidocaine results in an important reduction in pain for up to 24 hours in adults with chronic neuropathic pain, with modest benefits extending up to 3 weeks compared with placebo. Evidence suggests that these effects are dose-related and greater in central versus peripheral chronic neuropathic pain.

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Presenting Author: Dinesh Kumbhare
Submitting Author: Jeremy P. Steen

Senior Author: Mark W. Crawford

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Bradley C. Johnston: PhD - Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
• Lisa Isaac: MD - Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
• Marin Taylor: BSc - Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
• Theo Tackey: RRT - Department of Respiratory Therapy, The Hospital for Sick Children, Toronto, ON, Canada
• Kwame Agyei: MD - Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
• Kishore S. Jaiswal: BHSc - KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
• Jessie Cunningham: MISt - Health Sciences Library, The Hospital for Sick Children, Toronto, ON, Canada
• Laura Langer: MSc - KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
• Sindhu R. Johnson: PhD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
• Robert Simpson: PhD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
• Andrea Furlan: MD, PhD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
• Dinesh Kumbhare: MD, PhD - Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
• Mark W. Crawford: MD - Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada