Long-Term IV Lidocaine for Chronic Pain: A Summary of a Safety Study
Intravenous (IV) lidocaine is a numbing medicine that, given slowly through a vein, is sometimes used as a non-opioid option for chronic pain. Some patients receive infusions again and again over months or years. That raises a fair question: does the risk build up with each treatment, and who is most at risk? A 2026 study in Pain Medicine looked at serious adverse outcomes after long-term IV lidocaine therapy.
This summary is based on the published abstract. Read the abstract on PubMed
What the authors did
This was a retrospective cohort study, meaning the researchers looked back at existing records. It covered 1,093 patients treated with IV lidocaine at a hospital-based pain clinic in Israel from 2014 to 2022, with 15,820 infusions in total.
- A serious adverse outcome was defined as an emergency department visit within 14 days of an infusion.
- The team tested possible predictors, including cardiovascular disease, a history of stroke, diabetes, and the total number of infusions a patient had received.
- One statistical method looked at repeated infusions in the same person. This helped separate a true effect of each infusion from the simple fact that patients treated longer have more time for something to happen.
- A second analysis kept only events that were plausibly related to lidocaine’s known effects.
What they found
- Overall rate: 55 patients (5.0%) had a serious adverse outcome.
- Total exposure: having more than 50 cumulative infusions was the strongest predictor (odds ratio 12.58).
- Per-infusion risk: the risk of each individual infusion stayed stable and did not rise with infusion number (odds ratio 1.00).
- Stroke history: this was linked to events at first, but not in the refined analysis limited to 30 plausibly lidocaine-related events. The authors suggest the first link reflected underlying disease rather than the treatment.
- Heart disease: pre-existing cardiovascular disease became a significant predictor in the refined analysis (odds ratio 3.88). This fits with lidocaine’s known effects on the heart’s electrical activity.
The authors conclude that IV lidocaine showed a favorable safety profile with a low rate of serious outcomes, and that the data suggest no cumulative physiological toxicity.
Limitations
This was a single-clinic, retrospective study, so it shows associations rather than proof of cause. An emergency department visit is a broad measure and is not always caused by the infusion; the secondary analysis was designed to address this. The abstract does not describe the doses or monitoring used, so this summary does not cover them.
Safety takeaways
- More treatments, more chances. Patients with many infusions had more events overall, but the risk of any single infusion did not appear to grow.
- Heart conditions matter most. Ischemic heart disease and heart rhythm problems were the main risk factors. The authors support enhanced cardiac monitoring for these patients.
- Reassess over time. Periodic review of benefits and risks is suggested for patients who receive many infusions.
- Share your full history. Tell your care team about any heart condition, prior stroke, and all medicines before an infusion.
- Speak up during and after treatment. Report palpitations, dizziness, ringing in the ears, or other new symptoms right away.
Reference
- Shalit N, Shalit R, Levitan M, Afgin H, Morag O, Goor-Aryeh I. Cumulative exposure and cardiovascular risk: predictors of serious adverse outcomes following long-term intravenous lidocaine therapy for chronic pain. Pain Med. 2026 Oct 1;27(10):1123-1128. DOI: 10.1093/pm/pnag066. PMID: 42166744. Abstract: https://pubmed.ncbi.nlm.nih.gov/42166744/
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This article is educational information, not legal or medical advice.
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