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Dr. P: How effective is lidocaine for severe pain from fibro?
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calicogirl63 posted:
Hello, Dr. P and FMily!

My rheumatologist gave me six lidocaine patches to try for a severe fibro flare up last week. After cutting up one patch to apply to the worst areas--shoulder and low back---I was shocked! The cool-water feeling almost immediately stopped the pain.....I was nearly euphoric!! I have been experiencing pain at the 9/10 level in many areas for so long...I was so tense from the widespread pain that I was in tears..........After applying the patches, I actually slept for a few hours that first night.

Sooooo...Dr. P: is lidocaine safe to use long-term? Please say yes!! How does the lidocaine work? Does it break the pain memory in the painful areas?

Also, I have a question about IV lidocaine. I found some info about using lidocaine to treat fibro pain here:
http://www.livestrong.com/article/10419-treat-fibromyalgia-with-lidocaine/
I was surprised to read about IV use of lidocaine! Does the lidocaine by IV actually work? I have had the injections of lidocaine in my neck muscles, but with minimal pain relief.

What do you think, Dr. P? How safe/effective is lidocaine for fibro? I called my insurance company to see if the Lidoderm patches were covered, and they are if the prescription is pre-approved. A $30 co-pay I can do; no coverage, the patches are $200 on average, and I NO can do that!

Thanks for any answers/opinions/stories you or any others here at the fibro board can offer. I am down to one patch!! I still cannot believe the improvement that lasts hours after removing the patch. I hope it is a safe "tool" in the old toolbox for me and others!!!

Robbie
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calicogirl63 responded:
I am just "bumping" this post up so it won't get lost! Please reply if you have used lidocaine patches or IV for fibro pain.

Robbie
 
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Mark Pellegrino, MD responded:
Hi Robbie,

It's great that you've benefitted from the lidocaine patches! I've found lidocaine to be very helpful in treating my patients and yes, I've found this medicine to be safe and helpful in the long term when used as prescribed!

Topical or injected lidocaine works as a local anesthetic by stabilizing the nerve membrane and preventing depolarization. It mainly blocks sodium ionic movements required to propagate a nerve impulse, thus we feel numb or have decreased pain (analgesia) on a temporary basis. IV lidocaine works more on the central nerves to temporarily desensitize the amplified pain. Perhaps this treatment helps our pain memories "reset" themselves to a lower, calmer level.

The info you referenced in your post lists the exact 3 ways I use lidocaine in my practice:

  1. Lidocaine patches. These are helpful for areas of particular pain, use 12 hours on, 12 hours off. The patches can be cut to fit an area. I tell patients not to get them wet, and never apply to an area of damaged skin and watch for any redness, itching, blistering or reaction. They shouldn't be used in someone who is sensitive or allergic to lidocaine, of course.
  2. Trigger point injections. I typically use a mixture of 1% lidocaine and a trace of dexamethasone and inject a dose into the worst painful muscle areas causing the worst pain and spasms. These can be repeated if they work well, as measured by such things as decreased pain of at least 50% lasting at least a month, improved motion, function, abilities etc.
  3. IV lidocaine therapy. This form is used for central pain or central neuropathy symptoms such as widespead skin sensitivity and burning, extreme pain to touch, and numbness & tingling esp in hands and feet. I call this felling like a "live wire." It involves a lot of monitoring (heart rhythm, pulse ox, blood pressure, nurse supervision during treatment) so it's not offered in a lot of places. I consider it "successful" if it gives 30% or more improvement in overall pain that lasts at least 3 weeks or longer.

I hope you are able to continue with the effective treatment. Work with your doctor for any questions about lidocaine treatments specifically for you.

Dr. P
 
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carissaf replied to Mark Pellegrino, MD's response:
I have been recieving lidocaine injections for over a year. They do help numb my worst spots, but the initial pain from the shot escalates the pain before it starts to work. Sometimes it takes hours sometimes a couple of days. I just got some last week in my back and they have already wore off. They usally seem to work a little longer as long as I do not use those muscles, but if I do the pain comes back full on. I have never even heard of the patches, but I see that they are expensive, and I do not have health insurance. I guess I will stick to the shots. I get them often; is there any bad side effects that I should now about since I get them sometimes weekly and I try to go longer between shots but I do get six per visit and I go at the usally twice a month.
Fill your life with simple joys :)
 
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Mark Pellegrino, MD replied to carissaf's response:
Hi carissaf,

I'm glad you find the trigger point injections (TPI) helpful as I too have found this treatment to be very effective in many of my patients as part of the overall fibro program.

I tell my patients that it may take a few days for the TPI to work bcause the injection sticks can hurt temporarily. Unfortunately there's no way to get the lidocaine deep into the painful tender/trigger points of the muscles except by sticking a needle into them (YIKES!) So the needle injection sites may be sore, as expected, initially, until they settle down and the injection benefits take over.

TPI can be helpful for a while, hopefully at least 3 to 4 weeks at a time. This varies, though. They don't provide "permanent" benefit but if the patient and treating doctor determine them to be helpful and tolerated, they can certainly be repeated or used regularly. Any treatment for FM needs to be coordinated by the fibro doc to come up with the best long term program.

Dr. P
 
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wheelinlady replied to calicogirl63's response:
My physician has been using both lidocaine patches and localized injections for over two years to treat my pain from post-polio syndrome, a condition that shares many characteristics with fibro myalja. A third component of my treatment is the use of my Tens unit. Lidocaine has been highly effective in decreasing my pain. If anyone tells me about chronic pain they are suffering with I usually recommend that they ask their physician about lidocaine patches. I use my tens unit on areas of intense pain and to help less pain until my next injections. There has been a shortage of the lidocaine used in the injections for about 8 months now. Because of trying to have enough of it for all of her patients who receive the injections I am having to wait twice as long between receiving these shots. Personally I have found that the injections do not hurt unless a muscle is very tight; even then, the relief I receive from pain makes it more than worth it.
 
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Wolfsong452 replied to wheelinlady's response:
I tried talking to my pain management doctor about the patches, they said that they'd found that in their practice that they DIDN'T work on FM patients.

I've also tried the trigger point injections, Out of 2 of the 4 injections, I had an falling accident almost immediately afterward. NO, I don't think the injections caused it. I had my first injection, went downtown to my lawyers, with in the hour. Coming out of their bathroom I'd forgot there was a step up. So tripped over the step falling flat on my face. So that kind of knocked out any help that the injections could have helped.

The other 2 times there was either a fall on the ice, hey, happens to anyone, but with me, same day of the injection. Or, there was extreme stress in my family, or work.

I mean extreme. Found out sister has 4th stange renal failure. Also, my best friend of 40 years, her mother has 4th stage renal failure.

so,


My Physical Therapist tried the Lidocaine patches on my rotator cuff and my chronic tendonistis. yep, me, had a reaction to the adhesive, (the glue) not the lidocaine, so, it caused a huge red looking like a burn on where ever the patch had been placed...

taking off the patch,still would take 3-6 days for the burn looking spot to get better.

Hey, Dr. P. can I pass on your information on the dose etc. of the trigger point injections? also, regarding the IV information?

I get the muscle spasms, sometimes so bad that I have to get up walk around stomping my feet shaking my arms, even sounding off, ahhhh, eeee, eeeek, eeeee,

got to do something for this.
 
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ChristineMcDaniel replied to Wolfsong452's response:
Hi...I just wanted to add that I just had two lipocain injections this Thursday. It hurt so much I cried, but my RA said I was really tender. My left hip was sore the rest of that day and night and the next day too, but the third day it felt alot better. I was able to go to my grandsons birthday and stand for longer period of time without feeling like my hips and lower back was going to BURST!. I was given a few days off so I return to work tomorrow and I stand majority of the day. I sure hope it helps. I can go back in 3-4 wks to do my neck, arms, and shoulder area.
 
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Wolfsong452 replied to ChristineMcDaniel's response:
good luck I hope it works for you.

what with my shoulder problem, and other assorted things, there is always something that reacts and flares up, even if it isn't the FM.

so knees might flare up, get a cortizone shot, ok, knees are better, or shoulder will hurt, get a cortizone shot there, them FM will flare up.

so, no matter what,I'm screwed!

Good Luck, keep us informed!


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