# Short-Duration Systemic Lidocaine for the Management of Refractory Chronic Pain in Pediatrics

## TL;DR

Lidocaine infusions may provide short-term relief for children with chronic pain that doesn't respond to other treatments, but long-term benefits are unclear.

## Contribution

This study evaluates the safety and short-term effectiveness of lidocaine infusions for refractory chronic pain in pediatric patients.

## Key findings

- Lidocaine infusions were well tolerated in 350 administrations to 184 pediatric patients.
- Approximately 42% of infusions resulted in immediate, statistically significant pain reduction.
- Pain improvement was not sustained in patients with follow-up data.

## Abstract

Objectives: Multidisciplinary management of chronic pain benefits many patients, although some continue to experience refractory pain. Administration of lidocaine infusions (LI) to manage certain chronic pain conditions has been reported in adults, but evidence is limited for its utility in managing pediatric chronic pain. We reviewed LIs for refractory pain in children to (1) describe the patient population that received LI and (2) evaluate the response to LI. Methods: With IRB approval, a retrospective review of patients receiving LI for refractory pain between 2016 and 2021 was conducted at Boston Children’s Hospital. Demographic, medical, pain, sleep, and school function information was collected through self-report and from the electronic medical record. Longitudinal outcomes for a subset of these patients were analyzed using the Chronic Pain Repository database. Results: During the study period, 3959 patients presented for management of chronic pain. Among this population, 184 (5%) patients aged 22 years or younger ultimately received LI as part of their pain management. A total of 350 LIs were administered and were well tolerated. During approximately 42% of the infusions, patients experienced an immediate statistically significant decrease in pain scores. Among the patients with follow-up data, pain improvement was not sustained. Discussion: LI for the treatment of chronic pain appears safe and may be useful for managing refractory pain in pediatrics. Although approximately half of the patients who received LI reported an immediate positive response, the small follow-up sample did not show a continued response. Study limitations preclude demonstrating long-term efficacy of LI; therefore, a prospective study is critical.