Short-Duration Systemic Lidocaine for the Management of Refractory Chronic Pain in Pediatrics
Abstract
1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Demographic Information
2.3. Lidocaine Infusion
2.4. Tolerability of the Infusion
2.5. Pain Scores
2.6. Psychological Questionnaires
- Functional Disability Inventory (FDI): The FDI is a validated 15-item self-report questionnaire examining one’s ability to complete physical tasks. The FDI has been validated for use in pediatric chronic widespread pain [19].
- Pain Catastrophizing Scale for Children (PCS-C) [20] is a validated 13-item self-report measure of negative thoughts and behaviors related to pain.
- Fear of Pain Questionnaire, Child Report (FOPQ-C) [21] is a 24-item measure that assesses child perceptions of pain-related fears and avoidance behaviors.
- Pediatric Quality of Life Inventory (PedsQL) [22] is a self-reported instrument that measures physical, social, emotional, and school function on a 5-point Likert rating scale. It is well-validated for use with youth with chronic pain.
2.7. Data Analysis
3. Results
3.1. Population Description
3.2. Lidocaine Infusions
3.3. Events and Side Effects
3.4. Immediate Response to LI
3.5. Prospective Follow-Up
Pain Scores
3.6. Psychological Functioning
3.7. Physical Functioning
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
LI | Lidocaine infusion |
BCH | Boston Children’s Hospital |
MPC | Multidisciplinary Pain Clinic |
CPDR | Chronic Pain Data Repository |
LAST | Local anesthetic severe toxicity |
NRS | Numeric Rating Scale |
FLACC | Face, Legs, Activity, Cry Consolability scale |
INRS | Individualized Numeric Rating Scale |
FDI | Functional Disability Inventory |
PCS-C | Pain Catastrophizing Scale for Children |
FOPQ-C | Fear of Pain Questionnaire, Child Report |
PedsQL | Pediatric Quality of Life Inventory |
ED | Emergency Department |
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Inclusion Criteria | Potential Exclusion Criteria |
---|---|
The patient has debilitating pain from
|
|
Lidocaine Dosing | Infuse over | |
---|---|---|
Initial dose | <50 kg: 2 mg/kg IV >/=50 kg: 100 mg IV | 30 min |
Subsequent dose | <50 kg: 2 mg/kg IV >/=50 kg: 100 mg IV | Subsequent 60 min |
Total dose | <50 kg: 4 mg/kg IV >/=50 kg: 200 mg IV | Total 90 min |
No LI | Yes LI | ||
---|---|---|---|
(n = 2489) | (n = 126) | p-Value | |
Age (mean; SD) | 14.92 (3.36) | 15.50 (2.34) | 0.056 |
Gender | |||
Female | 1954 (78.5) | 112 (88.9) | 0.043 * |
Male | 499 (20.0) | 13 (10.3) | |
Prefer to Self-Describe | 14 (0.6) | 0 (0.0) | |
Transgender | 22 (0.9) | 1 (0.8) | |
Developmental history | |||
Problems during pregnancy | 660 (27.6) | 27 (22.0) | 0.204 |
Walking by 8 months | 2265 (94.2) | 121 (97.6) | 0.162 |
Talking by 18 months | 2184 (91.3) | 119 (96.7) | 0.052 |
Prematurity | 320 (13.5) | 13 (11.6) | 0.743 |
Early sensitivity | 544 (22.7) | 21 (17.2) | 0.195 |
Use of assistant devices | |||
Boot | 133 (5.3) | 5 (4.0) | 0.639 |
Crutches | 263 (10.6) | 11 (8.7) | 0.612 |
Walker | 57 (2.3) | 1 (0.8) | 0.422 |
Wheelchair | 197 (7.9) | 8 (6.3) | 0.64 |
School | |||
Enrolled in school | 2255 (92.2) | 121 (97.6) | 0.042 * |
Home schooled | 262 (11.6) | 9 (7.5) | 0.217 |
Missed school day due to pain (mean; SD) | 20.4 (28.0) | 22.7 (27.9) | 0.423 |
Plan 504 | 556 (26.8) | 47 (49.5) | <0.001 ** |
Home tutoring | 185 (8.9) | 13 (13.8) | 0.154 |
Plan IEP | 378 (18.2) | 12 (13.0) | 0.26 |
Gym at school | |||
Modified gym | 434 (18.9) | 24 (21.1) | 0.636 |
No | 1448 (63.2) | 67 (58.8) | |
Yes | 410 (17.9) | 23 (20.2) | |
Extracurricular activities | 1379 (57.3) | 82 (66.1) | 0.066 |
Limited extra activities due to pain | 2186 (91.3) | 116 (93.5) | 0.482 |
Sleep | |||
Wake up at night times | |||
0 | 753 (31.9) | 26 (22.2) | 0.014 * |
1–2 | 1069 (45.3) | 51 (43.6) | |
3–4 | 417 (17.7) | 29 (24.8) | |
5+ | 119 (5.0) | 11 (9.4) | |
Caffeinated drinks day | |||
0 | 1707 (71.5) | 80 (66.1) | 0.603 |
1–2 | 652 (27.3) | 39 (32.2) | |
3–4 | 27 (1.1) | 2 (1.7) | |
5+ | 2 (0.1) | 0 (0.0) | |
Tired in the morning (yes) | 1321 (55.0) | 79 (64.8) | 0.044 * |
Health utilization | |||
Physician visits (mean; SD) | 5.32 (4.74) | 5.55 (3.88) | 0.594 |
Emergency room visits (mean; SD) | 0.87 (2.03) | 0.65 (1.26) | 0.224 |
Overnight hospitalizations (mean; SD) | 0.39 (1.71) | 0.15 (0.63) | 0.125 |
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© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Riley, B.; Shusterman, C.; O’Neil, T.; Donado, C.; Lobo, K.; Koka, A.; Nelson, S.; Ribeiro, M.; Dinakar, P.; Solodiuk, J.; et al. Short-Duration Systemic Lidocaine for the Management of Refractory Chronic Pain in Pediatrics. Children 2025, 12, 1349. https://doi.org/10.3390/children12101349
Riley B, Shusterman C, O’Neil T, Donado C, Lobo K, Koka A, Nelson S, Ribeiro M, Dinakar P, Solodiuk J, et al. Short-Duration Systemic Lidocaine for the Management of Refractory Chronic Pain in Pediatrics. Children. 2025; 12(10):1349. https://doi.org/10.3390/children12101349
Chicago/Turabian StyleRiley, Bobbie, Christine Shusterman, Teresa O’Neil, Carolina Donado, Kimberly Lobo, Anjali Koka, Sarah Nelson, Monique Ribeiro, Pradeep Dinakar, Jean Solodiuk, and et al. 2025. "Short-Duration Systemic Lidocaine for the Management of Refractory Chronic Pain in Pediatrics" Children 12, no. 10: 1349. https://doi.org/10.3390/children12101349
APA StyleRiley, B., Shusterman, C., O’Neil, T., Donado, C., Lobo, K., Koka, A., Nelson, S., Ribeiro, M., Dinakar, P., Solodiuk, J., Schechter, N., & Greco, C. (2025). Short-Duration Systemic Lidocaine for the Management of Refractory Chronic Pain in Pediatrics. Children, 12(10), 1349. https://doi.org/10.3390/children12101349