Continuous Intravenous Lidocaine for Refractory Cancer Pain in Palliative Care: A Multicenter Feasibility Study

Area of Science:

• Palliative Care
• Pain Management
• Pharmacology

Background:

• Opioid-refractory cancer pain poses a significant challenge in palliative care.
• Intravenous lidocaine is explored as a potential analgesic for severe pain conditions.
• Feasibility and efficacy of continuous low-dose lidocaine in this population require evaluation.

Purpose of the Study:

• To assess the feasibility and tolerability of continuous low-dose intravenous lidocaine infusion.
• To explore the impact of lidocaine on pain outcomes in opioid-refractory cancer pain.
• To evaluate lidocaine's potential in real-world palliative care settings.

Main Methods:

• A multicenter, randomized, double-blind, placebo-controlled feasibility study.
• Patients received either intravenous lidocaine (5-8 mg/kg/day) or placebo for 48 hours.
• Pain intensity assessed via Numeric Pain Intensity Scale; primary endpoint was ≥30% pain reduction.

Main Results:

• Thirty-five patients analyzed (18 lidocaine, 17 placebo).
• No significant difference in pain reduction between lidocaine and placebo groups.
• Lidocaine was well-tolerated with mild adverse events; 61% required dose escalation.

Conclusions:

• Continuous low-dose intravenous lidocaine did not demonstrate significant analgesic benefit over placebo in opioid-refractory cancer pain.
• The study was underpowered due to not reaching the planned sample size.
• Findings highlight challenges in palliative care research and inform future trial designs.