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The ability to predict oral Oxcarbazepine efficacy through intravenous Lidocaine responses emphasizes the need for personalized therapy while cautioning against potential adverse events obscuring analgesic benefits.
According to a novel prospective cohort study published in ‘Medical Science Monitor’, administration of Lidocaine as intravenous (IV) infusion can help identify patients with neuropathic pain syndrome who are unlikely to benefit from Oxcarbazepine, helping to prevent unnecessary exposure to its potentially serious side effects.
Treating neuropathic pain is challenging due to serious adverse events from sodium-channel blockers like Oxcarbazepine, prompting this study to evaluate IV Lidocaine responses as predictors of treatment efficacy. Study investigators administered a single dose of IV Lidocaine (3 mg/kg) to patients diagnosed with neuropathic pain syndrome. They monitored pain levels using a numeric rating scale (NRS) and tracked any adverse effects. Afterwards, participants were prescribed Oxcarbazepine, starting at 150 mg and increasing by 150 mg every 3 days until they experienced a minimum of 50% pain relief or reached the maximum tolerated dose of 1800 mg daily.
Pain levels, need for rescue medication, and adverse effects were evaluated over the following weeks, with psychological assessments conducted initially and after 6 weeks. Out of 46 patients, 14 dropped out due to intolerable side effects, leaving 32 for final analysis. The results showed a substantial drop in average NRS scores from 6.8±1.7 at the start to 3.8±2.0 after IV Lidocaine and 4.1±2.3 following Oxcarbazepine (P<0.001). For Oxcarbazepine efficacy, the positive predictive value was 54.5%.
On the other hand, the negative predictive value was 76.2%, indicating that poor response to IV Lidocaine strongly predicts a lack of benefit from Oxcarbazepine. At the 6-week mark, 20 patients experienced a minimum of 30% decline in pain, while 11 achieved over 50% relief. Notably, quality of life and stress levels improved remarkably, as evidenced by EuroQol-Five Dimensions-Five Levels (EQ-5D-5L) and Depression, Anxiety & Stress Scales 21 (DASS-21) assessments.
Medical Science Monitor
Intravenous Lidocaine Response as a Predictor for Oral Oxcarbazepine Efficacy in Neuropathic Pain Syndrome: A Prospective Cohort Study
Sukunya Jirachaipitak et al.
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