Can lidocaine cream and lidocaine patch be used together for back pain?

Using Lidocaine Cream and Patch Together for Back Pain

Yes, lidocaine cream and lidocaine patch can be used together for back pain, as they both work locally with minimal systemic absorption and have complementary delivery mechanisms. 1

Mechanism of Action and Rationale

• Lidocaine blocks sodium ion channels required for the initiation and conduction of neuronal impulses, resulting in local anesthesia after topical application 1
• The combination approach may provide both immediate relief (cream) and sustained relief (patch):
  • Lidocaine cream provides immediate but shorter-duration pain relief
  • Lidocaine patches deliver medication gradually over 12-24 hours, providing sustained relief 1

Application Guidelines

• Lidocaine patches:

  • Available in over-the-counter 4% concentration or prescription 5% strength 1
  • Can be applied to the dorsal or plantar surface of the affected area 1
  • Up to 3-4 patches may be worn for 12-24 hours per day 1
  • Patches should be applied to intact skin only 1

• Lidocaine cream:

  • Can be applied to areas where patches may not adhere well or to complement patch coverage 1
  • Can be used for smaller or irregularly shaped painful areas 1

Efficacy for Back Pain

• Lidocaine patches have shown efficacy in chronic low back pain in several studies 2, 3
• In a case series of patients with chronic low back pain, lidocaine patches helped relieve various pain characteristics including general pain, shooting pain, burning pain, and allodynia 2
• A 6-week multicenter study showed significant improvements in pain intensity and quality of life measures in patients with acute/subacute, short-term chronic, and long-term chronic low back pain 3

Safety Considerations

• Pharmacokinetic studies have shown that systemic lidocaine levels remain within a safe range with doses of up to four patches in 24 hours 1
• Adverse reactions are rare, mild, and mostly related to skin rash 1
• Contraindications:
  • Advanced liver failure (due to decreased lidocaine clearance) 1
  • Application to broken or inflamed skin 1
  • Known hypersensitivity to amide anesthetics 1

Monitoring and Precautions

• Watch for signs of systemic absorption (dizziness, confusion, bradycardia) 1
• Perform periodic skin checks for irritation or sensitization 1
• Avoid excessive heat application over the areas where lidocaine is applied, as it may increase systemic absorption 1

Important Caveats

• The placebo effect may account for some of the pain relief experienced with lidocaine patches. A randomized double-blind study found no significant difference between 5% lidocaine patches and placebo patches in chronic back pain patients 4
• Patients with more severe and longer duration of pain may not respond as well to lidocaine treatments 1
• If inadequate pain relief is achieved with topical lidocaine, consider adding or switching to other analgesic approaches such as:
  • Oral medications (acetaminophen, NSAIDs, gabapentinoids) 1
  • Other topical agents (capsaicin, compounded amitriptyline-ketamine) 1