What is lidocaine cream used for in managing back pain?

Lidocaine Cream for Back Pain Management

Lidocaine cream is primarily effective as a topical analgesic for localized back pain, providing temporary relief by blocking sodium channels required for pain signal transmission, but it is not considered a first-line treatment for chronic back pain conditions. 1, 2

Mechanism of Action and Formulations

• Lidocaine works by blocking sodium ion channels required for the initiation and conduction of neuronal impulses, resulting in local anesthesia after topical application 1
• Available as cream, ointment, or patch formulations, with patches delivering lidocaine gradually over hours (potentially providing more effective relief) 1
• Commercial formulations include over-the-counter 4% concentration and prescription 5% strength patches 1, 2

Clinical Applications for Back Pain

Appropriate Uses:

• Localized back pain with neuropathic components 1, 3
• As part of multimodal pain management strategies for spine surgery patients 1
• For temporary relief of pain symptoms while addressing underlying causes 4, 5

Evidence of Effectiveness:

• In a case series of 34 patients with erythromelalgia at a tertiary center, most patients using lidocaine 5% patches reported pain improvement, though patients with more severe and longer-duration disease showed less response 1
• A 6-week pilot study of lidocaine patch 5% in patients with various durations of low back pain showed significant improvements in pain intensity and quality of life measures 5
• Some patients with chronic low back pain were able to reduce or discontinue other medications when lidocaine patches were added to their regimen 4

Limitations and Considerations

• Not recommended as monotherapy for chronic back pain conditions 1
• More effective for localized pain than for diffuse or deep-seated back pain 1, 3
• Should be considered as part of a broader treatment approach that may include:
  • Physical therapy and exercise 1
  • Other pharmacologic options (NSAIDs, acetaminophen, gabapentinoids) 1
  • Behavioral therapies for chronic pain 1

Safety Profile

• Generally well-tolerated with minimal systemic absorption when used as directed 1, 5
• Common side effects may include:
  • Skin reactions at application site 5
  • Dizziness (rare with topical application) 1
• No significant systemic absorption or toxicity reported in studies of topical application 1

Clinical Pearls

• Lidocaine patches may be more effective than creams or ointments due to gradual delivery over hours 1
• Apply to the area of maximal pain for best results 5
• Can be used as an adjunct to other pain management strategies to potentially reduce reliance on systemic medications, especially opioids 4, 3
• For perioperative spine surgery pain management, lidocaine may be considered as part of a multimodal approach 1

Comparative Effectiveness

• For moderate to severe chronic back pain or hip/knee osteoarthritis, a treatment strategy starting with acetaminophen or NSAIDs generally results in better pain control with fewer side effects compared to starting with opioids 1
• For neuropathic pain syndromes, tricyclic antidepressants, SNRI antidepressants, selected anticonvulsants, or transdermal lidocaine are recommended 1
• Evidence suggests that exercise therapy for back pain reduces pain and improves function immediately after treatment, with improvements sustained for at least 2-6 months 1