Prediction of Individual Analgesic Response to Intravenous Lidocaine in Painful Diabetic Peripheral Neuropathy

Marko S. Todorovic, Karen Frey, Robert A. Swarm, Michael Bottros, Lesley Rao, Danielle Tallchief, Kristin Kraus, Kathleen Meacham, Kristopher Bakos, Xiaowei Zang, Jong Bong Lee, Leonid Kagan, Simon Haroutounian

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Intravenous lidocaine can alleviate painful diabetic peripheral neuropathy (DPN) in some patients. Whether quantitative sensory testing (QST) can identify treatment responders has not been prospectively tested. Materials and Methods: This was a prospective, randomized, double- blind, crossover, placebo-controlled trial comparing intravenous lidocaine to normal saline (placebo) for painful DPN. Thirty-four participants with painful DPN were enrolled and administered intravenous lidocaine (5 mg/kg ideal body weight) or placebo as a 40-minute infusion, after a battery of QST parameters were tested on the dorsal foot, with a 3-week washout period between infusions. Results: Thirty-one participants completed both study sessions and were included in the final analysis. Lidocaine resulted in a 51% pain reduction 60 to 120 minutes after infusion initiation, as assessed on a 0 to 10 numerical rating scale, while placebo resulted in a 33.5% pain reduction (difference=17.6%, 95% confidence interval [CI], 1.9%-33.3%, P=0.03). Neither mechanical pain threshold, heat pain threshold, or any of the other measured QST parameters predicted the response to treatment. Lidocaine administration reduced mean Neuropathic Pain Symptom Inventory paresthesia/ dysesthesia scores when compared with placebo by 1.29 points (95% CI, -2.03 to -0.55, P=0.001), and paroxysmal pain scores by 0.84 points (95% CI, -1.62 to -0.56, P=0.04), without significant changes in burning, pressing or evoked pain subscores. Discussion: While some participants reported therapeutic benefit from lidocaine administration, QST measures alone were not predictive of response to treatment. Further studies, powered to test more complex phenotypic interactions, are required to identify reliable predictors of response to pharmacotherapy in patients with DPN.

Original languageEnglish
Pages (from-to)65-76
Number of pages12
JournalClinical Journal of Pain
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2022

Keywords

  • Chronic pain
  • DPN
  • Diabetic peripheral neuropathy
  • Lidocaine
  • Neuropathic pain

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