Is systemic administration of local anesthetic agents effective for relieving neuropathic pain? A Cochrane Review summary with commentary

BACKGROUND: The role of systemic use of local anesthetics in the treatment of neuropathic pain (NP) is still unclear. OBJECTIVE: To assess the efficacy and safety of systemic local anesthetics for NP. METHODS: To summarize and to discuss the rehabilitation perspective on the published Cochrane Systematic Review 'Systemic administration of local anesthetic agents to relieve neuropathic pain' by Challapalli V et al. RESULTS: The review included 30 RCTs including patients with NP treated with iv lidocaine, oral mexiletine, lidocaine and mexiletine, or oral tocainide. Low-to-moderate quality of the evidence suggest that intravenous lidocaine or oral mexiletine may slightly reduce NP vs placebo, but the efficacy of these drugs is comparable to anticonvulsants or morphine. CONCLUSIONS: Systemic administration of local anesthetics is not supported by scientific evidence for pain relief as well as for functional improvement.