Topical lidocaine
Small trials found the 5% lidocaine patch eased nerve pain after shingles more than a drug-free patch. Across nerve pain, pooled evidence was very low quality, with about 1 extra responder per 14 or 15 treated. Reviews found lower pain after surgery in most analyses. Side effects matched placebo patches. Labels warn of toxicity when too much is applied.
- Status
- In the US, lidocaine at up to 4% in patches, creams, rolls and sprays is sold over the counter as a topical anesthetic for temporary pain relief, for adults and children 12 and older. The 5% lidocaine patch (Lidoderm and generics) is a prescription drug, FDA-approved for pain after shingles (postherpetic neuralgia).
- Also called
- lidocaine patch, lidocaine 5% patch, Lidoderm, lidocaine 4% patch, Salonpas Lidocaine, Aspercreme Lidocaine, lidocaine cream, lidocaine 4% cream, LMX4, lignocaine, numbing cream, topical anesthetic
- Taken for
- nerve pain after shingles, nerve pain, back pain, neck and shoulder pain, muscle aches, pain after surgery, sprains and bruises, numbing skin before injections or cosmetic procedures
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help3
- ModerateShown to ease nerve pain after shingles more than a drug-free patch, in small trials, and in a network review more than pregabalin or capsaicin.
- ModerateShown to ease acute muscle, joint and nerve pain more than placebo patches, and not shown to differ from NSAIDs in two trials, on low to moderate quality evidence.
- LimitedOne small trial found 4% lidocaine cream lowered pain from cosmetic botulinum toxin injections compared with a vehicle cream.
Reported risks4
- LimitedThe label warns that larger areas, longer wear, extra patches, heat or broken skin can raise blood lidocaine enough to cause seizures, heart rhythm problems and collapse.How often is not known
- LimitedThe label warns local anesthetics, including lidocaine patches, have been linked to methemoglobinemia, more likely with G6PD deficiency, infants under 6 months and certain other drugs.How often is not known
- LimitedThe label warns the toxic effects of lidocaine patches and class I heart rhythm drugs such as mexiletine add together.How often is not known
- LimitedThe label warns that even a used 5% patch holds at least 665 mg of lidocaine, enough to harm a small child or pet that chews or swallows it.How often is not known
What people take it for, and what was found
Shown to help3
Nerve pain after shingles (postherpetic neuralgia)
Shown to ease nerve pain after shingles more than a drug-free patch, in small trials, and in a network review more than pregabalin or capsaicin.
Compared with a vehicle patch without lidocaine, and no treatment [1]; placebo, pregabalin, gabapentin and capsaicin in a network [2]
The numbers and sources
- Effect
- In a single-dose crossover trial, pain intensity was lower on the lidocaine patch than the vehicle patch from 4 to 12 hours. In a 2-week trial in people who had already responded, those on lidocaine stayed in the trial a median 14 days before pain returned, against 3.8 days on vehicle [1]. In a network meta-analysis, the 5% plaster lowered pain from baseline more than placebo (-15.50, 95% CI -18.85 to -12.16) and more than capsaicin, gabapentin and pregabalin, with pain relief comparable to gabapentin. Placebo-controlled studies found less allodynia and low adverse event rates [2].
- Population
- 35 and 32 people with postherpetic neuralgia in the label trials [1]; 20 studies of postherpetic neuralgia [2].
- Sources
- [1], [2]
- Caveats
- The trials were small, and one enrolled only people who had already responded. The network review noted the limited size and quality of the included studies [2].
Acute local pain in the emergency department
Shown to ease acute muscle, joint and nerve pain more than placebo patches, and not shown to differ from NSAIDs in two trials, on low to moderate quality evidence.
Compared with placebo patches and NSAIDs [10]
The numbers and sources
- Effect
- Trials found lidocaine patches eased musculoskeletal and nerve pain more than placebo patches, though heterogeneity prevented pooling. In two trials against NSAIDs, pain relief did not differ [10].
- Population
- 10 trials with 523 patients with acute localized pain [10].
- Sources
- [10]
- Caveats
- Small trials, with no pooled effect size [10].
Numbing skin before injections
One small trial found 4% lidocaine cream lowered pain from cosmetic botulinum toxin injections compared with a vehicle cream.
Compared with a vehicle cream [13]
The numbers and sources
- Effect
- People pretreated with 4% lidocaine cream on both sides of the face reported less procedural pain than controls on vehicle cream [13].
- Population
- 24 adults having injections for crow's feet, 6 per group [13].
- Sources
- [13]
- Caveats
- One trial with 6 people per group, and the abstract gives no effect size.
Mixed results4
Nerve pain of other causes
Mixed results: reviews found no good-quality evidence, and a 2025 analysis estimated 1 extra person with meaningful relief for every 14 or 15 treated, on very low certainty.
Compared with placebo [3][4][5]; other active treatments [3]
The numbers and sources
- Effect
- A Cochrane review of 12 studies found no first- or second-tier evidence and could not pool efficacy. Very low quality evidence from all but one study favored lidocaine on some measure of pain relief [3]. A 2015 meta-analysis could not determine a number needed to treat for lidocaine patches and rated their evidence quality below that of every other treatment [4]. A 2025 meta-analysis estimated a number needed to treat of 14.5 (95% CI 7.8 to 108.2) and number needed to harm of 178.0 for lidocaine 5% plasters, on very low certainty evidence [5].
- Population
- 12 studies with 508 adults with postherpetic, trigeminal, postsurgical or post-traumatic nerve pain [3]; 229 studies of drugs for nerve pain [4]; 313 trials with 48,789 adults [5].
- Sources
- [3], [4], [5]
- Caveats
- All Cochrane-included studies were at high risk of bias from small size or incomplete outcome reporting [3]. The reviews still placed lidocaine patches as a second-line option for peripheral nerve pain [4][5].
Pain after surgery
Mixed results: two reviews found lower pain after surgery with a lidocaine patch, by about 1.3 to 1.9 points out of 10, while an earlier, smaller review found no difference.
Compared with placebo patch or no patch [6][7][8]; placebo or no topical lidocaine [9]
The numbers and sources
- Effect
- Lidocaine patches lowered pain scores at 6 hours (MD -1.85, 95% CI -2.98 to -0.72) and 12 hours (MD -1.48, 95% CI -2.07 to -0.88), without more side effects, and their effect on morphine use was unclear [6]. A second review found lower pain at 12, 24 and 48 hours (MD -1.32, 95% CI -1.96 to -0.68), with no rise in satisfaction with pain control [7]. An earlier review of 5 trials found no difference in pain intensity (MD -9.1 mm, 95% CI -23.31 to 5.20), opioid use (MD -8.2 mg morphine equivalent, 95% CI -28.68 to 12.24) or hospital stay [8]. For lasting nerve pain after surgery, topical lidocaine raised the chance of global pain relief (RR 1.98, 95% CI 1.04 to 3.76) [9].
- Population
- 11 trials with 539 patients [6]; 16 trials with 918 patients [7]; 5 trials with 251 patients [8]; 7 trials with 585 patients with post-surgical nerve pain [9].
- Sources
- [6], [7], [8], [9]
- Caveats
- Heterogeneity was large [7][9], and the earlier review included unblinded studies [8].
Neck and shoulder muscle pain (myofascial pain)
One trial found the 5% patch eased upper trapezius pain more than a placebo patch a week after use ended, but not at day 7 or day 28.
Compared with a placebo patch [11]
The numbers and sources
- Effect
- Pain fell in both groups at day 7 with no difference. At day 14 the lidocaine group kept improving while the placebo group worsened (P=0.03), and neck disability was lower. By day 28 the groups did not differ [11].
- Population
- 60 adults with myofascial pain of the upper trapezius, 31 on lidocaine and 29 on placebo [11].
- Sources
- [11]
- Caveats
- One small trial.
Chronic low back pain
Limited evidence: a review found no randomized trial with substantial evidence for the 5% patch in chronic low back pain, only uncontrolled studies reporting relief.
Compared with no control group in most of the studies the review found [12]
The numbers and sources
- Effect
- A systematic search found seven articles. None was a randomized controlled trial with substantial evidence of benefit, while nonrandomized, uncontrolled studies suggested pain relief [12].
- Population
- Seven studies of the 5% lidocaine patch in chronic low back pain [12].
- Sources
- [12]
- Caveats
- A narrative review. No trial of the over-the-counter 4% patch for back pain was sourced.
Doses studied
The 5% patch label allows up to 3 patches applied once for up to 12 hours in 24 hours, on intact skin [1]. With 3 patches worn for 12 hours, about 3% of the dose (64 mg on average) was absorbed and mean peak blood lidocaine was 0.13 mcg/mL, about a tenth of the level used to treat heart rhythm problems. Levels did not build up over three days, though some people exceeded 0.25 mcg/mL, and the label places toxicity above 5 mcg/mL. At least 665 mg of lidocaine stays in a used patch [1]. The over-the-counter 4% patch label directs one patch at a time, worn for at most 8 hours, up to 3 to 4 times a day, for adults and children 12 and older [14]. The injection trial applied 4% cream before the procedure [13].
Risks
Reported risks4
Lidocaine poisoning from too much skin exposure
The label warns that larger areas, longer wear, extra patches, heat or broken skin can raise blood lidocaine enough to cause seizures, heart rhythm problems and collapse.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- The 5% patch label states that excessive dosing by applying to larger areas or for longer than the label directs could raise blood lidocaine to toxic levels, and that broken skin, heating pads, smaller patients, severe liver disease and impaired elimination raise levels. Systemic effects described include lightheadedness, confusion, tremors, convulsions, unconsciousness, slow heart rate, low blood pressure and cardiovascular collapse [1]. A review of a related cream of lidocaine with prilocaine found 9 published cases of systemic toxicity in children and 3 in adults, linked to excess amounts, large or diseased skin areas, long application, age under 3 months and other methemoglobin-raising drugs [15].
- Population
- Labeling statement [1]; 12 published cases with lidocaine and prilocaine cream [15].
- Sources
- [1], [15]
- Caveats
- Case reports give no rate. The review covers a cream that also contains prilocaine [15].
Methemoglobinemia (blood that carries less oxygen)
The label warns local anesthetics, including lidocaine patches, have been linked to methemoglobinemia, more likely with G6PD deficiency, infants under 6 months and certain other drugs.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- The label reports cases of methemoglobinemia with local anesthetic use, with signs such as gray or blue skin, headache, fast heart rate and shortness of breath, that may be delayed by hours. It names greater susceptibility with G6PD deficiency, congenital methemoglobinemia, heart or lung compromise and age under 6 months, and with other drugs that cause it: nitrates and nitrites such as nitroglycerin, other local anesthetics, dapsone, nitrofurantoin and sulfonamide antibiotics, antimalarials, some anticonvulsants, some cancer drugs, and acetaminophen [1].
- Population
- Postmarketing reports with local anesthetics, as described on the label [1].
- Sources
- [1]
- Caveats
- The label gives no rate for the patch.
Interaction with heart rhythm drugs
The label warns the toxic effects of lidocaine patches and class I heart rhythm drugs such as mexiletine add together.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- The label advises caution with Class I antiarrhythmic drugs such as tocainide and mexiletine, because toxic effects are additive and potentially synergistic, and says lidocaine absorbed from all local anesthetic products must be counted together [1].
- Population
- Labeling statement [1].
- Sources
- [1]
- Caveats
- Predicted from how the drugs act, with no rate given.
Accidental exposure in children and pets
The label warns that even a used 5% patch holds at least 665 mg of lidocaine, enough to harm a small child or pet that chews or swallows it.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- The label states a new or used patch could cause serious effects in a small child or pet who chews or ingests it, although this risk has not been evaluated for the patch, and directs storage and disposal out of reach [1]. The label states safety and benefit in children have not been established [1].
- Population
- Labeling statement [1].
- Sources
- [1]
- Caveats
- No cases or rates are given on the label.
Checked, no increase found1
Skin reactions and side effects at the patch site
Not shown to raise side effects over placebo patches in pooled trials, though the label lists mild, short-lived redness, itching, burning and blistering at the site.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Topical lidocaine did not raise adverse events against placebo or no lidocaine after surgery (RR 1.04, 95% CI 0.93 to 1.16, high certainty) [9] or in acute pain (RR 0.90, 95% CI 0.48 to 1.67) [10]. Pooled multiple-dose studies of nerve pain showed no clear effect on adverse events or withdrawals [3]. The label lists blisters, bruising, burning, depigmentation, dermatitis, swelling, redness, irritation and itching at the site, generally mild and resolving within minutes to hours [1].
- Population
- 7 trials with 585 patients [9]; 10 trials with 523 patients [10]; 12 studies with 508 adults [3].
- Sources
- [9], [10], [3], [1]
- Caveats
- Few events in small trials [3]. The label gives no rate for site reactions [1].
Possible, not studied in people1
Use in pregnancy
Not studied in people. Rat studies of lidocaine at up to 30 mg/kg found no fetal harm, and the patch has not been studied in pregnancy.
No study in people. This rests on animal studies.
The numbers and sources
- Effect
- The label states the patch has not been studied in pregnancy, that reproduction studies in rats at doses up to 30 mg/kg found no evidence of fetal harm, and that lidocaine crosses the placenta. It is excreted in breast milk at a milk to plasma ratio of 0.4 [1].
- Population
- Rats (animal) [1].
- Sources
- [1]
- Caveats
- Animal studies do not always predict effects in people [1].
Claims tested and not found
- That a lidocaine patch after surgery raises satisfaction with pain control. One review found lower pain scores but no significant rise in patient satisfaction [7].
Sources
- FDA label (DailyMed). Lidoderm (lidocaine patch 5%). TPU Pharma, Inc. 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=db0092f5-02a0-4076-ac32-969f075a6ab1
- Wolff RF, Bala MM, Westwood M, Kessels AG, Kleijnen J. 5% lidocaine-medicated plaster vs other relevant interventions and placebo for post-herpetic neuralgia (PHN): a systematic review. Acta Neurologica Scandinavica. 2011. https://doi.org/10.1111/j.1600-0404.2010.01433.x
- Derry S, Wiffen PJ, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.cd010958.pub2
- Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology. 2015. https://doi.org/10.1016/s1474-4422(14)70251-0
- Soliman N, Moisset X, Ferraro MC, et al. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. The Lancet Neurology. 2025. https://doi.org/10.1016/s1474-4422(25)00068-7
- Koo CH, Kim J, Na HS, Ryu JH, Shin HJ. The effect of lidocaine patch for postoperative pain: A meta-analysis of randomized controlled trials. Journal of Clinical Anesthesia. 2022. https://doi.org/10.1016/j.jclinane.2022.110918
- Wu X, Wei X, Jiang L, et al. Is Lidocaine Patch Beneficial for Postoperative Pain?: A Meta-analysis of Randomized Clinical Trials. The Clinical Journal of Pain. 2023. https://doi.org/10.1097/ajp.0000000000001135
- Bai Y, Miller T, Tan M, Law LS, Gan TJ. Lidocaine patch for acute pain management: a meta-analysis of prospective controlled trials. Current Medical Research and Opinion. 2015. https://doi.org/10.1185/03007995.2014.973484
- Mao P, Zhang Y, Liu B, et al. Effect and safety profile of topical lidocaine on post-surgical neuropathic pain and quality of life: A systematic review and meta-analysis. Journal of Clinical Anesthesia. 2024. https://doi.org/10.1016/j.jclinane.2023.111219
- Felemban A, Allan S, Youssef E, Verma R, Zehtabchi S. Lidocaine patch for treatment of acute localized pain in the emergency department: a systematic review and meta-analysis. European Journal of Emergency Medicine. 2024. https://doi.org/10.1097/mej.0000000000001158
- Lin YC, Kuan TS, Hsieh PC, et al. Therapeutic effects of lidocaine patch on myofascial pain syndrome of the upper trapezius: a randomized, double-blind, placebo-controlled study. American Journal of Physical Medicine & Rehabilitation. 2012. https://doi.org/10.1097/phm.0b013e3182645d30
- Santana JA, Klass S, Felix ER. The Efficacy, Effectiveness and Safety of 5% Transdermal Lidocaine Patch for Chronic Low Back Pain: A Narrative Review. PM&R. 2020. https://doi.org/10.1002/pmrj.12366
- Carruthers A, Carruthers J. Single-center, double-blind, randomized study to evaluate the efficacy of 4% lidocaine cream versus vehicle cream during botulinum toxin type A treatments. Dermatologic Surgery. 2005. https://doi.org/10.2310/6350.2005.31304
- FDA label (DailyMed). Salonpas Pain Relieving Lidocaine 4% Flex patch, Drug Facts. Hisamitsu Pharmaceutical Co., Inc. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9507f727-c49f-4de4-9d64-b6d977d568ab
- Tran AN, Koo JY. Risk of systemic toxicity with topical lidocaine/prilocaine: a review. Journal of Drugs in Dermatology. 2014. https://pubmed.ncbi.nlm.nih.gov/25226014/