Lidocaine Patch for Knee Pain
Lidocaine patches are effective for knee pain, particularly for osteoarthritis and localized neuropathic pain following knee surgery, with evidence showing significant pain reduction and improved physical function over 2-12 weeks of treatment. 1, 2
Evidence for Knee Osteoarthritis
A randomized controlled trial demonstrated that lidocaine patch 5% was equally effective as celecoxib 200 mg/day for osteoarthritis knee pain, with no significant differences in pain reduction measured by WOMAC scores over 12 weeks 1
In a 2-week open-label study, lidocaine patch 5% significantly reduced all pain quality measures (sharp, dull, burning) in 100 patients with moderate-to-severe knee osteoarthritis, whether used as monotherapy or add-on therapy (p < 0.001) 3
The patch improved not only pain intensity but also physical function and stiffness in knee osteoarthritis patients, with benefits evident within the first week of treatment 3
Evidence for Post-Surgical Knee Neuropathic Pain
In patients with localized neuropathic pain after knee surgery, lidocaine patch 5% reduced dynamic mechanical allodynia by ≥30% in 96% of patients (23/24) and by ≥50% in 83% of patients (20/24) over 3 months 2
The patch also improved cold pain thresholds (p = 0.001) and maximal mechanical pain thresholds (p = 0.007) in post-surgical knee pain 2
Benefits were observed as early as day 7 and sustained through 3 months of treatment 2
Application Protocol for Knee Pain
Apply up to 3-4 patches to cover the painful knee area, ensuring application to intact skin only 4, 5
Use a 12-hour on, 12-hour off schedule to minimize systemic absorption risk 6
Available in 4% over-the-counter or 5% prescription strength formulations 4, 5
Safety Profile
Adverse events are rare and mild, primarily limited to local skin reactions (rash or irritation) in approximately 11% of patients 1
Systemic lidocaine levels remain within safe range even with four patches applied over 24 hours, with peak blood levels at only 0.1 micrograms/ml 5
No treatment-related adverse events were reported in the monotherapy group for knee osteoarthritis 3
Important Contraindications and Precautions
Contraindicated in advanced liver failure and known hypersensitivity to amide anesthetics 5, 6
Avoid excessive heat application over patches, as this increases systemic absorption 5, 6
Monitor for signs of systemic toxicity: dizziness, confusion, bradycardia 5, 6
Remove patches before starting intravenous lidocaine therapy 5
Avoid using within 4 hours of other local anesthetic interventions 6
When Lidocaine Patches Are Insufficient
Add gabapentinoids (gabapentin starting at 50mg three times daily or pregabalin) for neuropathic pain components 5
Consider oral NSAIDs or acetaminophen for additional analgesia 4
Combine with physical therapy or other non-pharmacological approaches 4, 5
For refractory cases, consider intra-articular lidocaine injections (0.5% lidocaine 7mL series of three injections spaced 1 week apart), which showed sustained pain reduction for 3 months in knee osteoarthritis 7
Common Pitfall to Avoid
The most critical error is exceeding the 12-hour application period—this increases systemic toxicity risk without providing additional benefit 6. Always maintain the 12-hour off period regardless of persistent pain.