Intravenous lidocaine does not provide additional pain reduction beyond placebo in probable nociplastic chronic low back pain
In a randomized equivalence trial, 84 adults with probable nociplastic chronic non-specific low back pain received either intravenous lidocaine or saline placebo, both alongside multimodal pain management. At 3 months, the between-group difference in VAS pain was 0.24 (90% CI -0.33 to 0.81), within the prespecified equivalence margin of ±1.5, confirming therapeutic equivalence. Lidocaine did not improve pain but did improve sleep quality (mean difference in change score 1.81; 95% CI 0.49-3.14; p=0.027).
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Intravenous lidocaine does not provide additional pain reduction beyond placebo in probable nociplastic chronic low back pain The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
Intravenous lidocaine does not provide additional pain reduction beyond placebo in probable nociplastic chronic low back pain
This conclusion is most relevant to: Adults with chronic non-specific low back pain with probable nociplastic pain features.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Intravenous Lidocaine Does Not Provide Additional Pain Reduction Beyond Placebo in Probable Nociplastic Chronic Low Back Pain: A Randomized Controlled Equivalence Trial. (Pain medicine (Malden, Mass.), 2026) —
How It Works
The proposed biological pathway:
- ▸Lidocaine is a sodium channel blocker that may modulate neuronal hyperexcitability
- ▸In nociplastic pain, central sensitization may involve altered sodium channel activity
- ▸Repeated infusions could potentially reduce central sensitization
- ▸However, no additional analgesic benefit over placebo was observed
Who Might Benefit
Evidence fit by population:
- ▸Adults with chronic non-specific low back pain with probable nociplastic pain features
Recommended Dose
1 mg/kg bolus followed by 4 mg/kg infusion weekly for 4 weeks
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Single-center trial with relatively small sample size (n=84)
- ▸Equivalence margin of ±1.5 VAS units may be debated as clinically meaningful
- ▸Background multimodal therapy may have masked or diluted any lidocaine-specific effect
- ▸Probable nociplastic pain classification may not be precise
Frequently Asked Questions
Does intravenous lidocaine reduce pain in chronic low back pain?▼
No, this trial found no additional pain reduction beyond placebo in patients with probable nociplastic chronic low back pain.
What was the effect of lidocaine on sleep quality?▼
Lidocaine significantly improved sleep quality compared to placebo, with a mean difference in change score of 1.81 points on the PSQI.
What is the equivalence margin used in this trial?▼
The prespecified equivalence margin was ±1.5 VAS units, and the observed difference was well within this range.
Were there any safety concerns with lidocaine infusions?▼
Adverse events were more common in the lidocaine group but were mild, transient, and self-limiting.
References
- 1.Pahari S, Hazra S, Das PP. “Intravenous Lidocaine Does Not Provide Additional Pain Reduction Beyond Placebo in Probable Nociplastic Chronic Low Back Pain: A Randomized Controlled Equivalence Trial..” Pain medicine (Malden, Mass.), 2026. PMID: 42548132 DOI: 10.1093/pm/pnag093