Ordering Lidocaine Patches for Knee Pain
Lidocaine 5% patches (Lidoderm) require a prescription from a healthcare provider, as they are FDA-approved specifically for postherpetic neuralgia, though they are widely used off-label for other localized pain conditions including osteoarthritis of the knee. 1
How to Obtain a Prescription
Contact Your Healthcare Provider
- Schedule an appointment with your primary care physician, orthopedist, rheumatologist, or pain specialist to discuss your knee pain 2
- The provider will evaluate whether lidocaine patches are appropriate for your specific condition 2
What to Expect During Your Visit
Your healthcare provider will likely:
- Assess the nature of your knee pain - lidocaine patches work best for well-localized pain rather than diffuse or deep joint pain 2
- Review your medical history, particularly checking for contraindications such as advanced liver failure (absolute contraindication) or hepatic insufficiency 2
- Consider your current medications to avoid interactions with other local anesthetic interventions 2
Evidence for Use in Knee Pain
Limited but Positive Data for Osteoarthritis
The evidence for lidocaine patches in knee osteoarthritis is mixed but generally shows modest benefit. The American Geriatrics Society notes that lidocaine 5% patches have been used widely off-label for osteoarthritis despite FDA approval only for postherpetic neuralgia 2. A pilot study demonstrated significant improvements in pain qualities associated with knee OA when lidocaine patches were used for 2 weeks 3.
However, major osteoarthritis guidelines do not strongly recommend lidocaine patches as first-line therapy. The 2012 American College of Rheumatology guidelines for knee OA do not include topical lidocaine in their pharmacologic recommendations, focusing instead on acetaminophen, oral/topical NSAIDs, and intra-articular corticosteroids 2. The 2020 ACR/Arthritis Foundation update similarly does not feature lidocaine patches prominently 2.
Neuropathic Pain Component
If your knee pain has a neuropathic component (burning, shooting, or allodynia), lidocaine patches may be more effective. The Mayo Clinic guidelines recommend lidocaine 5% patches as first-line therapy for localized neuropathic pain, with a maximum of 3 patches daily for 12-18 hours, requiring a 3-week trial to assess efficacy 2.
Prescription Details
Standard Dosing
- Apply up to 3 patches once daily to intact skin covering the most painful area 1
- Maximum application time: 12 hours within a 24-hour period 2, 1
- Patches may be cut into smaller sizes if needed 1
- Clothing may be worn over the application area 1
Trial Period
- Allow at least 3 weeks to adequately assess effectiveness 2
- For erythromelalgia (though not your condition), guidelines suggest 4 weeks minimum 2
Important Considerations
Safety Profile
Lidocaine patches have excellent tolerability with minimal systemic absorption. The most common adverse effects are mild local skin reactions 2. Pharmacokinetic studies show systemic lidocaine levels remain safe with up to 4 patches in 24 hours, though the FDA label recommends maximum 3 patches 2.
Cost and Availability
- Prescription strength is 5% lidocaine 1
- Over-the-counter 4% lidocaine patches are available without prescription, though they may be less effective than the 5% prescription version 2
- One study found OTC lidocaine 3.6% with menthol 1.25% was non-inferior to prescription 5% lidocaine for back pain and arthritis 4
Realistic Expectations
Postoperative knee studies show conflicting results. One study found no significant additional pain relief when lidocaine patches were added after total knee arthroplasty 5, while another recent study showed significant reduction in pain scores and opioid consumption after knee arthroscopy 6. The benefit appears modest at best for mechanical knee pain.
Alternative First-Line Approaches
Before or alongside requesting lidocaine patches, consider that stronger evidence supports:
- Topical NSAIDs (diclofenac) for knee OA - strongly recommended by multiple guidelines 2
- Acetaminophen as initial therapy for musculoskeletal pain 2
- Exercise and weight loss (if overweight) - strongly recommended 2
The decision to prescribe lidocaine patches for knee pain is at your provider's discretion, as this represents off-label use. 2