Can You Use Lidocaine Patches for Hip Pain?
Lidocaine patches are not recommended for hip osteoarthritis pain because the hip joint lies too deep beneath the skin surface for topical lidocaine to penetrate effectively and reach the source of pain. 1
Why Lidocaine Patches Don't Work for Hip Pain
The 2019 American College of Rheumatology/Arthritis Foundation explicitly states that "the depth of the joint beneath the skin surface suggests that topical NSAIDs are unlikely to confer benefit" in hip OA, and therefore "the Voting Panel did not examine use in hip OA." 1 This same anatomical limitation applies even more strongly to lidocaine patches, which have similar or lesser penetration depth compared to topical NSAIDs. 1
Additionally, the ACR/Arthritis Foundation guideline notes that "insufficient data exists to make recommendations about the use of topical lidocaine preparations in OA." 1 This lack of evidence, combined with the anatomical barrier, makes lidocaine patches an inappropriate choice for hip pain.
What Actually Works for Hip Osteoarthritis Pain
First-Line Pharmacologic Options
Oral NSAIDs are strongly recommended as the initial oral medication of choice for hip OA, regardless of anatomic location, and are recommended over all other available oral medications. 1
Oral acetaminophen may be considered when NSAIDs are contraindicated, though evidence is weaker (consensus recommendation). 1
Second-Line Options
Intra-articular corticosteroid injections are strongly recommended for hip OA and demonstrate short-term efficacy. 1 These should be performed with ultrasound guidance when available to ensure accurate drug delivery into the joint. 1
Physical therapy could be considered for mild-to-moderate symptomatic hip OA (moderate strength recommendation). 1
What to Avoid
Intra-articular hyaluronic acid injections should NOT be used for hip OA (strong recommendation against). 1
Oral opioids should NOT be used for treatment of symptomatic hip OA (consensus recommendation). 1
Special Context: Trauma and Acute Hip Fractures
The only scenario where lidocaine patches have a role near the hip is as part of multimodal analgesia in elderly trauma patients, but this is for superficial soft tissue pain, not intra-articular hip pain. 1
For acute hip fractures specifically, the 2023 WSES guidelines strongly recommend:
- Peripheral nerve blocks (such as fascia iliaca compartment block) at presentation to reduce opioid use. 1
- Multimodal analgesia including acetaminophen, gabapentinoids, NSAIDs, and lidocaine patches for superficial pain components only. 1
Common Pitfall to Avoid
Do not confuse the use of lidocaine patches for superficial musculoskeletal pain (where they work well for localized back pain, knee OA, or neuropathic pain) 2, 3, 4, 5, 6 with their complete lack of utility for deep joint pain like hip OA. 1 The hip joint's depth makes topical therapies ineffective, unlike the knee where lidocaine patches have demonstrated efficacy. 5, 6, 7