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The effect of intravenous lidocaine on nociceptive processing in diabetic neuropathy
Flemming W Bach1, Troels S Jensen, Jens Kastrup
1Department of Neurology, Gentofte Hospital, CopenhagenDenmark Department of Neurology, Rigshospitalet, CopenhagenDenmark Department of Clinical Physiology, Bispebjerg Hospital, CopenhagenDenmark Department of Clinical Neurophysiology, Gentofte Hospital, CopenhagenDenmark Department of Neurology, Hvidøre Hospital, CopenhagenDenmark.
Abstract:
In a double-blind controlled design, 7 patients with painful diabetic neuropathy received lidocaine 5 mg/kg or saline intravenously over a period of 30 min. Thermal sensibility quantified by thermotest was not affected by lidocaine. In 3 of the patients nociceptive flexion reflex thresholds could be determined. The threshold was increased by lidocaine and returned to pre-infusion level within 10 days. Lidocaine also increased the threshold in 4 healthy subjects, but did not affect the Hoffmann reflex. These results suggest that lidocaine exerts its pain-relieving effect on the spinal level in diabetic neuropathy.
Insights
Lidocaine effectively relieved pain in patients with diabetic neuropathy by acting on the spinal cord. This intravenous treatment increased pain reflex thresholds, suggesting a localized effect on nerve pathways.
Area of Science:
- Neurology
- Pharmacology
Background:
- Diabetic neuropathy is a common complication of diabetes, often causing significant pain.
- Current treatments for neuropathic pain have limitations, necessitating research into alternative therapies.
Purpose of the Study:
- To investigate the efficacy and mechanism of action of intravenous lidocaine in treating painful diabetic neuropathy.
Main Methods:
- A double-blind, controlled study involving 7 patients with painful diabetic neuropathy.
- Intravenous administration of lidocaine (5 mg/kg) or saline over 30 minutes.
- Assessment of thermal sensibility, nociceptive flexion reflex thresholds, and Hoffmann reflex.
Main Results:
- Lidocaine did not alter thermal sensibility.
- Lidocaine increased nociceptive flexion reflex thresholds in patients and healthy subjects.
- The effect on reflex thresholds persisted for up to 10 days.
- Lidocaine did not affect the Hoffmann reflex.
Conclusions:
- Intravenous lidocaine demonstrates potential for pain relief in diabetic neuropathy.
- The findings suggest that lidocaine's analgesic effect in this condition is mediated at the spinal cord level.