Combination of IV Lidocaine and Ketamine Shows Greater Pain Relief in Refractory Chronic Pain: Study
Thailand: A study published in Pain Medicine suggests that intravenous infusions of Lidocaine and Ketamine can provide meaningful pain relief in patients with Chronic Pain that does not respond to standard therapies. The research also found that combining the two drugs may offer additional benefits in pain reduction and quality of life.
Managing refractory chronic pain remains a major challenge in clinical practice. Many patients continue to experience severe symptoms even after prolonged multimodal treatment approaches, including medications and non-pharmacological therapies. Intravenous analgesic infusions have therefore emerged as a potential option for patients who fail to respond to conventional strategies.
The study was led by Kanita Kositanurit from the Pain Management Research Unit, Department of Anesthesiology at Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, Thailand. The researchers aimed to evaluate the effectiveness and safety of intravenous lidocaine, ketamine, and a combination of the two drugs in patients suffering from refractory chronic pain.
For this purpose, the team conducted a retrospective analytic study involving patients treated at an outpatient pain clinic between January 2020 and November 2024. Eligible participants had persistent severe pain, defined as a numerical rating scale (NRS) score greater than 6 out of 10, despite at least three months of multimodal pain management. Patients received one of three treatment strategies: intravenous lidocaine infusion, intravenous ketamine infusion, or a combination of both medications.
The primary outcome assessed in the study was immediate pain relief following the infusion. Researchers also evaluated longer-term outcomes, including pain reduction at one and three months, improvements in quality of life using the EQ-5D-5L questionnaire, and potential links between patient characteristics and treatment response.
The researchers reported the following findings:
- A total of 120 patients with Chronic Pain were included in the analysis.
- All treatment groups receiving intravenous Lidocaine, Ketamine, or their combination showed significant reductions in pain scores shortly after the first infusion.
- The mean reduction in Numerical Rating Scale (NRS) pain scores was 3.09 points in the lidocaine group, 2.30 points in the ketamine group, and 3.95 points in the combination therapy group.
- Pain relief persisted beyond the immediate post-infusion period and was maintained at 1-month and 3-month follow-up assessments.
- Patients receiving the combination of lidocaine and ketamine generally showed greater pain reduction at certain time points compared with those receiving either drug alone.
- Quality-of-life scores improved during the study, with the combination therapy group demonstrating the most pronounced improvement at the 3-month follow-up.
- The findings suggest that combining lidocaine and ketamine may provide additional benefits beyond pain reduction alone.
- Adverse effects occurred in approximately 7.5% of patients and were mild and self-limiting.
Overall, the researchers concluded that intravenous infusions of lidocaine, ketamine, and their combination can provide both immediate and sustained pain relief for patients with refractory chronic pain. The results indicate that combination therapy may offer enhanced benefits compared with monotherapy and could be considered as part of the therapeutic options in specialized pain management settings.
Reference:
Kositanurit, K., Chalermkitpanit, P., Limtrakool, N., & Assavanop, S. Analgesic efficacy of intravenous lidocaine vs ketamine in refractory chronic pain: A retrospective analytic study with 3-month follow-up. Pain Medicine. https://doi.org/10.1093/pm/pnag022
Next Story