Whenever a patient comes into the emergency department with a complaint of musculoskeletal pain, I always try to look for different solutions to try to help them get some relief. This is especially important for patients who are in serious pain, but who are looking to avoid drugs that could be addictive. I always try to emphasize the importance of heat, ice, elevation, stretching, and alternative methods other than pills that may help patients with pain relief. But one of my go-to treatments lately has been the use of the lidocaine patch. While this is still pharmacologic, the lidocaine patch offers a different method of pain relief for patients.
I have given patients all sorts of medications for issues such as back pain, including narcotics, muscle relaxers, anti-inflammatories, and steroids, and often times patients report that they get the most pain relief with the lidocaine patch. They experience such relief that they make sure to request a prescription for it. Unfortunately, the name brand lidocaine patch with 5% lidocaine is often very expensive and insurance may not cover it. Until recently, I would write a caveat on the patient’s prescription noting that if this was not covered by insurance, then a 4% cream could be substituted. However, over the past several months, popular over-the-counter companies have begun to sell lidocaine patches with 4% lidocaine concentration. These are a great alternative for patients who would prefer the patch but cannot afford the prescription price.
One of my favorite reasons for using the lidocaine patch is that it targets the pain from a different direction. I always tell patients that instead of attacking the pain from the inside out, we may need to go from the outside in. Whether this statement has a mild placebo effect I am not sure, but because of the success the patches have on patients, I am going to continue saying it.
Of course, the normal rules for lidocaine use apply, and lidocaine patches should only be used as directed. I tell patients to refer to the directions on the box when using them. Some companies do not want patients to use the patch for longer than 12 hours, others do not want patients to use it for more than 8 hours, and others have different directions still. Therefore, I warn my patients that they need to read each box individually and not assume that all are used the same. I also advise patients to avoid putting heat on the area while using the patch, as they may not realize that this combination may be a dangerous idea.
I like to use lidocaine patches for all sorts of different complaints, including back pain, rib contusions, and post-herpetic shingle pain. It is a medication I consistently keep in mind and use whenever possible. It is great when a patient experiences pain relief while using these patches and when we can avoid narcotic medications, I consider it a winning situation.
Jillian Knowles, MMS, PA-C is an emergency medicine physician assistant in the Philadelphia area.