Subcutaneous Lidocaine For Cancer-Related Pain

British Columbia Cancer Agency33 enrolled

Overview

This study's primary objective is to test the hypothesis that a single infusion of subcutaneous lidocaine can cause a clinically useful reduction in cancer pain within 48 hours of infusion and lasting a minimum of 7 days. A clinically useful reduction in pain is defined by either a 2-point reduction (on a 0-10 scale) in the worst pain experienced over a 24-hour period, or a ≥30% reduction in 24-hour opioid requirement. We will use a composite endpoint of reduction in pain without increase in 24-hr opioid requirement or no decrease in pain with a ≥30% reduction in 24-hour opioid requirement.Subjects will receive either lidocaine or placebo, followed at least 1 week later by the alternate agent.

Ten mg/kg of lidocaine will be infused subcutaneously via a Baxter infusor over a 5.5 hour period in ambulatory adult cancer patients with a worst pain score of at least 4 out of 10 despite therapy with at least one opioid plus appropriate oral adjuvant analgesic(s). A clinically useful reduction in pain is defined by either a 2-point reduction (on a 0-10 scale) in the worst pain experienced over a 24-hour period, or a ≥30% reduction in 24-hour opioid requirement. The secondary objectives are 1) to determine whether any significant toxicities occur as a result of the infusion. For this study significant toxicity is considered as any adverse event which either leads to the infusion being terminated, or which leads to medical intervention, such as prescribing of another medication or equivalent treatment, 2) to determine the effect of Lidocaine infusion on QOL parameters as measured by the Patient Outcome Scale (POS) Questionnaire and 3) to determine the duration of response to lidocaine infusion. Subjects will fill out Brief Pain Inventory (BPI), Patient Outcome Scale (POS) periodically and medication logs daily while on study. On Days of treatment the subjects will have vital sign monitoring every 15 minutes for the 1st hour and then periodically as set out in the protocol.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Male or female patients 18 years of age or older * In or outpatients referred to the BCCA PSMPC Clinics with a diagnosis of cancer * Subjects must have somatic, visceral or neuropathic pain related to cancer * Pain intensity, measured by a worst pain score over the last 72 hours of ≥4 on a 0-10 numerical rating scale * Must have tried at least one opioid medication without adequate response or with significant side-effects for at least one week * For those with neuropathic pain, must have also tried at least one adjuvant analgesic, such as a tricyclic (unless contraindicated) or an anticonvulsant without adequate response or with significant side-effects for at least one week * Life expectancy of \> 3 months * Must be able to communicate symptoms indicating potential toxicity of Lidocaine * Must have a competent caregiver in the home overnight after each infusion * Must be willing to remain within 30 minutes of the Cancer Centre during each infusion Exclusion Criteria: * Clinically significant cardiac disease, i.e, cardiac failure, atrial fibrillation with slow ventricular rate (\<60), any degree of heart block * New analgesic treatment initiated in time frame which might have effect within one week of study drug. * Hyper or hypokalemia. * Liver failure (bilirubin ≥ 25 umol/L). * Renal failure (eGFR \<50% of normal) * Uncontrolled hypertension (\>160/90). * Hypotension (systolic \< 90). * Uncontrolled seizures. * Planned initiation of chemotherapy, radiotherapy or bisphosphonates within 30 days prior to treatment with study drug. * Received an investigational drug within 30 days prior to study. * History of allergy to lidocaine or other topical, local or infusional anesthetics.

Outcomes

Primary Outcomes

Number of Participants With Reduction in Worst Pain Intensity or Reduction in 24hr Opioid Dose of at Least 30% Without Worsening of Pain Scores

The primary outcomes measure is a binary variable indicating whether lidocaine caused a reduction in cancer pain within 48 hours of infusion and lasting a minimum of 7 days. Lidocaine will be considered to have caused reduction in cancer pain if the subject had either one of the following episodes and lasting a minimum of 7 days: 1. A 2-point reduction in severity of pain as assessed by the worst pain score in the last 24 hours (question 3) of the Brief Pain Inventory - Short Form (BPI), compared to the BPI pain score at baseline. Or: 2. ≥30% reduction in 24-hour opioid dose.

Time frame: 7 days

Secondary Outcomes

Quality of Life Question: Over the Past 3 Days, Have You Been Affected by Pain?

Effect of Lidocaine infusion on Quality Of Life parameters as measured by the Patient Outcome Scale (POS) Questionnaire Baseline scores were compared to an average post treatment score (taken immediately post treatment and on days 2, 3, and 7 following treatment) All POS questions were scored from 0 to 4 with lower scores requiring less clinical attention than higher scores