This novice pilot study tested for relief of chronic pain after intravenous lidocaine infusion, following arm or leg nerve injury, which can result in severe, difficult to relieve chronic pain. The response to intravenous lidocaine varies greatly, and pain experiences include body and mind factors and vary by individual. The team identified a lack of information on who might experience the best pain relief from intravenous lidocaine.
Tess Cramond Pain and Research Centre and Royal Brisbane and Women’s Hospital
Dr Gunjeet Minhas, Dr Andrew Claus, Dr Scott Farrell, Dr Angela Tognolini
QIMR Berghofer Medical Research Institute
Dr Emma Ballard
The University of Queensland
Emeritus Professor Maree Smith
The project was awarded $A19,902 through the ANZCA research grants program for 2022.
This novice pilot study tested for relief of chronic pain after intravenous lidocaine infusion, following arm or leg nerve injury, which can result in severe, difficult to relieve chronic pain. The response to intravenous lidocaine varies greatly, and pain experiences include body and mind factors and vary by individual. The team identified a lack of information on who might experience the best pain relief from intravenous lidocaine.
Much was learned about testing and infusion during the study, and the time required for recruitment. Six of those recruited over six months were included, with the pilot demonstrating that a future study would require around 30 months to recruit and test a target of 40 patients.
Among those recruited, questionnaires were used to probe pain-related lifestyle disruption, depression, anxiety, stress, and coping despite pain. Body and nervous system testing included temperature and pressure-related pain thresholds, one week before and after infusion. Daily pain levels diaries were used to measure effects of the infusions, blinded to patients and clinicians to isolate any effects of the drug or patient expectations.
Of the participating patients, one lidocaine recipient’s pain was halved over three months, who despite constant severe pain, was one of the least mentally distressed. Another had more pain after the infusion of saline placebo, was very distressed, and was more sensitive to pressure near their injury.
This was the first study to test this combination of mind and body measures in people having intravenous lidocaine infusion after nerve injury. Although sensory tests target how nerves behave, studies show they are only around 20% linked to questionnaire results. However, this study indicated that for patients with nerve injuries the sensory test outcomes were much more closely linked. More research is needed, but a take-home message is that we need to look beyond just treating the injured nerve and support the whole person.
Australian Pain Society, 44th Annual Scientific Meeting, 2024
- Oral presentation: Can peripheral neuropathic pain be centrally driven? Insights from correlation of peripheral quantitative sensory tests versus psychological questionnaires. Authors: Andrew Claus, Emma Ballard, Gunjeet Minhas, Melissa Cohen, Andre Van Zundert, Scott Farrell, Angela Tognolini, Maree Smith and Paul Gray.
- Poster presentation: Lidocaine Infusion Dose Optimisation for Pain After Injury to Nerves (LIDOPAIN): Pilot feasibility and patient profiles from a double-blind randomised placebo-controlled trial. Authors: Andrew Claus, Emma Ballard, Gunjeet Minhas, Melissa Cohen, Andre Van Zundert, Scott Farrell, Angela Tognolini, Maree Smith and Paul Gray.
Manuscript in preparation for submission to a peer reviewed journal.
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