Lidocaine Patch Order Management for Resolved Neck Pain
When a patient's neck pain has completely resolved, convert the lidocaine patch order to PRN (as needed) rather than canceling it entirely. 1
Rationale for PRN Conversion
The PRN approach is preferred over outright cancellation because:
- Myofascial neck pain frequently recurs, and having PRN access allows immediate treatment if symptoms return, avoiding delays in pain control 2, 3
- The FDA label explicitly states patients should "stop use" if the condition improves, which supports PRN dosing rather than scheduled administration when asymptomatic 4
- Lidocaine patches have an excellent safety profile with minimal systemic absorption, making PRN use low-risk even if the patient self-administers during symptom recurrence 1, 5
Practical PRN Ordering Instructions
When converting to PRN, specify:
- Apply up to 3 patches to the painful area for 12 hours, then remove for 12 hours 1, 6
- Use only when neck pain returns (define threshold as pain ≥3/10 on visual analog scale) 2
- Apply to intact skin only, never to broken or inflamed areas 1, 7
- Maximum frequency: once daily as needed 1
When to Cancel the Order Completely
Consider canceling rather than converting to PRN if:
- The patient has been pain-free for >3-6 months without any recurrence, suggesting resolution rather than remission 2
- The patient has contraindications such as advanced liver failure or known hypersensitivity to amide anesthetics 1
- The patient experienced adverse effects during previous use, such as skin irritation or allergic reaction 4
Clinical Pearls
- Educate the patient that if symptoms return and clear up within 7 days of PRN use, this is appropriate, but if symptoms persist beyond 7 days or worsen, they should contact their provider 4
- Monitor for recurrence patterns: if the patient requires PRN use more than 2-3 times per week, this suggests inadequate treatment of the underlying condition and warrants reassessment 8, 2
- Avoid excessive heat application over areas where patches are applied, as this increases systemic absorption 1