Can Lidocaine Patches Be Applied to Shoulder and Neck?
Yes, lidocaine 5% patches can be safely applied to the shoulder and neck for localized musculoskeletal or neuropathic pain, with up to 3-4 patches applied simultaneously for 12 hours daily, followed by a mandatory 12-hour patch-free interval. 1, 2
Application Protocol for Shoulder and Neck
Apply up to 3-4 patches simultaneously to intact skin covering the painful area in the shoulder or neck region, using either 4% over-the-counter or 5% prescription strength formulations 1, 2
Standard regimen is 12 hours on, 12 hours off to maintain safe pharmacokinetics and minimize skin irritation 1, 3
Patches must be applied only to intact, non-inflamed skin - never apply to broken, irritated, or swollen skin as this dramatically increases systemic absorption and toxicity risk 4, 1
Evidence Supporting Shoulder Application
A case series specifically demonstrated successful use of heated lidocaine-tetracaine patches for shoulder impingement syndrome, with patients achieving pain control using 12 hours-on/12 hours-off application 5
The National Comprehensive Cancer Network recommends lidocaine patches for myofascial pain and localized musculoskeletal pain, which includes shoulder and neck regions 1, 2
Safety Profile and Systemic Absorption
Minimal systemic absorption occurs even with four patches applied over 24 hours, with highest measured blood levels at only 0.1 micrograms/ml - well below toxic thresholds 1, 6
Pharmacokinetic studies confirm systemic lidocaine levels remain within safe range, making patches safer than oral systemic analgesics for localized pain 1, 7
Critical Precautions
Do not apply heat (heating pads, hot packs) over the patches, as this increases systemic absorption and toxicity risk 4, 1
Remove patches before starting any intravenous lidocaine therapy and avoid use within 4 hours of other local anesthetic interventions to prevent cumulative toxicity 8
Monitor for signs of systemic absorption: dizziness, confusion, bradycardia, drowsiness, disorientation, muscle twitching, or perioral numbness - though these are uncommon with proper topical use 1, 2
Do not bandage tightly over patches or occlude the application site 4
Efficacy Considerations
Lidocaine patches work best for well-localized, superficial pain rather than deep radicular or widespread pain distribution 1, 2
For neck pain with neuropathic components (radiculopathy), patches may provide partial relief but are less effective than for purely superficial musculoskeletal pain 1
Allow at least 3-4 weeks for an adequate therapeutic trial before determining efficacy 2
When Patches Alone Are Insufficient
If inadequate pain relief after 4 weeks, consider adding gabapentin starting at 50-100 mg three times daily, titrating to 900-3600 mg daily for neuropathic pain components 1, 3
Alternative: add pregabalin 50 mg three times daily, titrated to 100 mg three times daily if gabapentin fails 1
Consider capsaicin 8% patch for single application providing pain relief lasting up to 90 days 1
Absolute Contraindications
Advanced liver failure or significant hepatic dysfunction - hepatic impairment reduces lidocaine clearance by 60%, creating toxicity risk even with topical application 2
Known hypersensitivity to amide-type local anesthetics 2
Application to broken, cut, irritated, or inflamed skin 4, 1
Common Pitfall to Avoid
The most common error is applying patches to inflamed or irritated skin in the neck/shoulder area (such as over active dermatitis or sunburn), which dramatically increases systemic absorption - always ensure skin integrity before application 4, 1