What type of pain do lidocaine patches help with?

October 10, 2025 •

4 min read

The FDA has approved 5% lidocaine patches specifically for treating postherpetic neuralgia, a type of nerve pain following a shingles outbreak. These patches provide targeted, localized relief for certain pain types by delivering a local anesthetic directly through the skin.

Quick Summary

Lidocaine patches primarily treat localized neuropathic pain, such as postherpetic neuralgia, by numbing affected nerves. They also offer relief for other localized pain conditions, including certain types of chronic back pain and diabetic neuropathy, though some applications are off-label. The patches block sodium ion channels to prevent pain signal transmission.

Key Points

Primary Use: Lidocaine patches are primarily approved for and effective against postherpetic neuralgia, a type of nerve pain that can follow a shingles infection.
Neuropathic Pain: The patches target neuropathic pain by numbing localized nerve endings, blocking pain signals from reaching the brain.
Off-Label Applications: They are also used off-label for other localized neuropathic conditions like diabetic neuropathy, certain types of chronic back pain, and osteoarthritis, though evidence for these uses varies.
OTC vs. Prescription: Over-the-counter (OTC) patches typically contain 4% lidocaine, while prescription-strength patches contain 5% lidocaine and are specifically indicated for PHN.
Safe Usage: Proper application is crucial, including applying to intact skin, following wearing schedules advised by a healthcare provider, and avoiding external heat sources.
Mechanism of Action: The local anesthetic works by blocking voltage-gated sodium ($Na^+$) channels, which are responsible for nerve signal transmission.

Lidocaine patches offer targeted pain relief by delivering a local anesthetic directly to the skin to numb a specific area. This mechanism is particularly effective for certain types of localized neuropathic pain, where damaged or irritated nerves cause persistent discomfort. Understanding the specific applications and limitations is key to using this treatment effectively and safely.

The Primary Indication: Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is the most common and well-researched condition for which lidocaine patches are used. PHN is a long-lasting nerve pain that occurs in the area where a person previously had a shingles rash. The virus, which remains dormant in the nerves after a chickenpox infection, can reactivate and cause nerve damage.

The 5% lidocaine patch (often under the brand name Lidoderm, or generic) is a prescription-strength medication specifically indicated by the FDA for PHN. In patients with PHN, the nerve fibers in the affected skin become hypersensitive, leading to intense pain from even light touch, a condition known as allodynia. The patch's mechanism helps desensitize these nerve endings, providing significant pain relief. Studies have shown that lidocaine patches can offer modest but significant efficacy in treating the constant pain associated with PHN.

Off-Label Uses for Other Neuropathic Pain Conditions

While PHN is the main approved use, lidocaine patches are often used off-label for other localized neuropathic and chronic pain conditions. This includes situations where pain is caused by damaged nerves, but the cause isn't related to shingles.

Some conditions for which lidocaine patches might be used off-label include:

Diabetic Peripheral Neuropathy (DPN): This is a type of nerve damage that can occur in people with diabetes, most commonly affecting the feet and legs. Small-scale studies and clinical experience suggest lidocaine patches may be effective for some patients, particularly those with pain in a specific area.
Chronic Lower Back Pain: For patients with chronic, localized low back pain, particularly where nerve involvement is suspected, lidocaine patches may be used as an add-on therapy. Some older studies found positive results, but more robust research is needed.
Osteoarthritis Pain: Especially in localized joints, lidocaine patches have been investigated as an alternative or additional therapy when conventional treatments are insufficient. However, evidence is limited, and more large-scale trials are needed to confirm effectiveness.
Carpal Tunnel Syndrome: The patches may be used to help with pain and numbness caused by this condition, which involves nerve compression in the wrist.

It is crucial to note that off-label uses are based on clinical judgment and emerging research, not official FDA approval. A healthcare provider should always be consulted before using lidocaine patches for conditions other than PHN.

How Lidocaine Patches Work

Lidocaine is a local anesthetic that works by stabilizing neuronal membranes. The active ingredient blocks voltage-gated sodium ($Na^+$) channels, which are essential for initiating and conducting nerve impulses. By blocking these channels, lidocaine prevents the nerves from sending pain signals to the brain, resulting in localized numbing. Because the lidocaine is delivered topically, only a small amount is absorbed systemically, which minimizes the risk of systemic side effects and drug interactions compared to oral medications. This makes it a suitable option for localized pain, especially in patients who may not tolerate oral painkillers.

Usage Best Practices and Safety

To ensure safety and effectiveness, proper application and use of lidocaine patches are important.

Preparation: Clean and dry the application area. Ensure the skin is intact, with no cuts, rashes, or irritation.
Application: Apply the patch directly over the most painful area. Prescription patches (5%) are typically used according to a healthcare provider's instructions, often involving a wearing schedule.
Heat Avoidance: Avoid exposing the patch to external heat sources like heating pads or electric blankets, as this can increase absorption and risk of side effects.
Disposal: Fold used patches with the adhesive sides together before disposal to prevent accidental exposure to children or pets, as they still contain medication.

Comparison: Lidocaine Patches vs. Other Topical Treatments

Topical pain relief comes in various forms, each with its own advantages. Here is a comparison of lidocaine patches with other common topical analgesic treatments:


Feature	Lidocaine Patch	Capsaicin Patch	Diclofenac Patch/Gel	Menthol Patch
Mechanism	Local anesthetic; blocks sodium channels to numb nerves.	Desensitizes nerves by depleting substance P.	Non-steroidal anti-inflammatory drug (NSAID); blocks prostaglandin production to reduce inflammation.	Counterirritant; provides cooling sensation to distract from pain.
Primary Use	Localized neuropathic pain (e.g., PHN).	Neuropathic pain (e.g., PHN, DPN).	Localized arthritis pain, joint pain.	Mild muscle aches, sprains.
Onset	Several hours for full effect; noticeable effect within a week.	Can cause burning initially; relief develops over days to weeks.	Varies; often faster than patches for inflammation.	Rapid, provides immediate cooling sensation.
Duration	Varies depending on type and individual.	Can last up to 90 days (prescription strength).	Can provide relief for hours.	Lasts for a few hours.
Side Effects	Mild skin irritation, burning, redness; rare systemic effects.	Significant burning sensation, especially at first.	Skin irritation, rare systemic NSAID effects.	Skin irritation, rash.
Available As	Prescription (5%) and OTC (4%).	Prescription (8%) and OTC creams/patches.	Prescription (e.g., Flector) and OTC gels.	OTC.

Conclusion

Lidocaine patches are a safe and effective treatment, particularly for targeted neuropathic pain like postherpetic neuralgia. By blocking nerve signals at the site of the pain, they provide localized relief with minimal systemic side effects, making them a good option for patients who experience side effects with oral medications. While a prescription is needed for the stronger 5% patches approved for PHN, OTC 4% options are also available for minor aches and pains. For other conditions, such as diabetic neuropathy and chronic back pain, lidocaine patches are often used off-label, but their effectiveness can vary. It is essential to consult with a healthcare provider to determine if a lidocaine patch is the right treatment for your specific type of pain and to understand proper usage and safety precautions.

For more detailed prescribing and safety information, refer to the FDA label for Lidoderm (Lidocaine Patch 5%).

Frequently Asked Questions

Lidocaine patches work by delivering a local anesthetic that blocks nerve signals in a targeted area. By inhibiting sodium ($Na^+$) channels in the nerve cells, the patches prevent the nerves from sending pain impulses to the brain, creating a numbing effect.

The primary difference is the concentration of the active ingredient. Prescription patches contain a higher concentration of lidocaine (typically 5%) and are specifically approved for treating postherpetic neuralgia. OTC patches are a lower strength (typically 4%) and are for temporary relief of minor aches and pains.

No, you should not use a heating pad, electric blanket, or other external heat source on top of a lidocaine patch. The heat can increase the absorption of lidocaine into your bloodstream, raising the risk of serious side effects.

No, they are most effective for localized pain, particularly neuropathic pain caused by damaged nerves. They are less effective for generalized pain or pain resulting from inflammation, where other medications may be more suitable.

To prevent accidental ingestion by children or pets, used patches should be folded in half with the adhesive sides stuck together before being discarded in the trash. They still contain a significant amount of the active ingredient.

Common side effects are usually localized and mild, occurring at the application site. These include redness, burning, irritation, and itching. More serious, but rare, systemic side effects can occur with excessive use.

Yes, many lidocaine patches, including the prescription 5% variety, can be cut into smaller pieces with scissors before the release liner is removed. This allows for targeted application to smaller, painful areas.