IV Ketamine and Lidocaine may help Overcome Chronic Pain

January 5, 2023

Summary: Ketamine and lidocaine are anesthetics. While it is known that ketamine can provide pain relief, and lidocaine is good for local anesthesia, a new study shows that combining the drugs in an infusion may help in chronic pain treatment. A study done in a clinic in Canada found that combining the two medications, and given as an infusion over 45 minutes, could significantly reduce the pain score of patients living with conditions like fibromyalgia, diabetic neuropathy, and complex regional pain syndrome.

There are hundreds of ways to treat pain and innumerable medications. Still, there is nothing like one-size-fits-all when it comes to chronic pain treatment. It is because every person with chronic pain is different. The causes differ. Not only that, but often these are people living with multiple health conditions. Some of them can be sciatica pain, chronic neck pain or back pain. 

Further, things are made complicated by the fact that many chronic pains are poorly understood. For example, the underlying mechanism of arthritis is well understood, but finding the cause of low back is challenging. However, despite much research, what causes fibromyalgia or migraine is still unclear.

Thus, it is no surprise that doctors are looking for different ways to help their patients. Therefore, researchers from Canada found that giving their patients an IV infusion of lidocaine and ketamine could significantly help reduce chronic pain and help overcome pain. 

Here it is worth noticing that the use of ketamine for chronic pain relief is not new. As an anesthetic, it is known to help with the pain. However, the surprise is that combining it with lidocaine injection for pain management provided additional benefits. 

Of course, lidocaine is a local anesthetic used for local anesthesia or nerve blocks. But lidocaine has a limited role in pain management when given alone as a pain killer.

Therefore, it would be right to say that these findings are new and among the first report of a kind showing the benefit of combining ketamine with lidocaine. Moreover, researchers have been using this combination in their patients since 2013. Thus, they have a significant amount of data to prove that this combination works.

Ketamine Plus Lidocaine Injection for Pain Management

Since doctors in the clinic in Canada have been using this drug combination to treat chronic pains for years, they decided to assess its safety and efficacy. Therefore, they analyzed the health records of 670 patients receiving this treatment, with a mean age of 53. They found that most of them were living with conditions like fibromyalgia, diabetic neuropathy, postherpetic neuralgia, and complex regional pain syndrome. All of these are difficult-to-treat conditions characterized by intractable pain.

Usually, they have three infusions for each patient, though 38% of them received five or more infusions. Most of the patients reported significant benefits from the treatment. Moreover, they were patients who had been visiting the same clinic for several years. Almost all patients reported a 30% reduction in pain scores or more. Half of the patients reported more than 75% improvement in their pain scores. Pain scores improved regardless of sex, age, and diagnosis.

When it comes to dosage, they started with 4.5 mg/kg of lidocaine along with 10 mg of ketamine, and then they titrated the dose according to the patient’s response. However, they kept the maximum limit to 600 mg lidocaine and 40 mg ketamine over 45 minutes. Exceeding this dosage results in a much greater risk of adverse effects.

Although these findings are remarkable, despite the common use of lidocaine or ketamine in pain management, no one combined them earlier or used them separately. However, the study has some limitations, as it did not follow up with the patients after discharge from the facility.

Nonetheless, doctors are convinced that their therapy provides long-term benefits, and they have a reason to believe. Most of the patients were regular clients of the clinic and had been visiting the clinic at least every two months for the last twelve years. 

Doctors think that there is a reason to believe that the therapy works, as combining lidocaine with ketamine is safe for chronic pain relief. It can help in the chronic pain treatment and sciatica pain management. Apart from the chronic pain conditions in which Canadian researchers used the combination, it may also be helpful for those living with cancer pain and neuropathic pains due to chemotherapy. As well, using the combo may help limit opioid use.

By Gurpreet Singh Padda, MD, MBA, MHP