options for management of intractable pain
Continuous lidocaine infusion in the home

Virginia Jarvis, RN, RM, BScN, MPC, Catherine Smyth, MD, PhD, FRCPC and
Edward J. Fitzgibbon MD, MSc, CCFP

Pain is a complex physiologic process that involves a variety of mechanisms within the peripheral, central and autonomic nervous systems. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

 

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Why not?
Patients with advanced cancer may exhibit complex pain syndromes and can develop pain that is completely or partially refractory to opioids. How to help such patients is a recurring theme in palliative care and frequently requires innovative multidisciplinary approaches. This article describes a joint initiative between The Ottawa Hospital Regional Cancer Centre and The Ottawa Hospital Pain Clinic to adapt intravenous lidocaine infusion — a technique normally used only in hospital acute care settings — to home care for a terminal cancer patient suffering from severe neuropathic pain. All other options for managing this patient’s pain had been exhausted, and once her pain was controlled, she expressed a strong desire to be at home. To make living at home with a continuous lidocaine infusion possible, a multidisciplinary group developed new policies and procedures and conducted education sessions with all the caregivers involved. The protocol that was developed has been successfully employed to help an increasing number of patients at The Ottawa Hospital.
 
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