Background     The 5% lidocaine patch is a prescription topical analgesic developed to treat peripherally generated neuropathic pain. It is approved in the US to treat post-herpetic neuralgia (PHN). This Fast Fact reviews its mechanism of action, research data, and dosage information. Notably, an over the counter 4% lidocaine patch is also available in the US. Currently there appear to be no published clinical data about its efficacy alone or in comparison to the 5% patch.

Mechanism of action    The lidocaine patch is believed to provide analgesia by reducing aberrant firing of sodium channels on damaged pain fibers directly under the patch. Less than 5% of the lidocaine is absorbed, an insufficient dose to cause systemic effects or local anesthesia (patients do not feel numb under the patch) (1,2). Nociceptive pain generation (such as sensitivity to pinprick, or hot or cold painful stimuli) is not affected (3,4). Tachyphylaxis has not been formally investigated; case reports indicate some patients have used the patch successfully for over a decade.

Research data     In randomized, placebo-controlled trials, the lidocaine patch is effective for PHN and acute post-operative pain, but not for other pain syndromes. It has shown modest (10-20 mm decrease in pain on the 100 mm visual analog scale) but significant efficacy in PHN in randomized, placebo-controlled trials (1,5). Multiple studies have also demonstrated modest efficacy for acute-post operative pain (6). Typically, the patch is placed on intact skin just adjacent to a surgical wound. Overall, the data are inconclusive as to whether the lidocaine patch reduces post-operative opioid need. There are no other pain syndromes for which the patch has been shown to be effective in placebo-controlled trials. There are a multitude of case reports suggesting efficacy for various other syndromes including chronic low back pain, acute bone fractures, painful diabetic neuropathy, osteoarthritis, and cancer pain (7,8). There is strong evidence it is not effective for chronic low back pain or painful diabetic neuropathy (9,10), and a lack of high-quality data for other syndromes. Great caution is necessary in interpreting results of non-blinded, non-controlled clinical reports due to the high likelihood of a placebo effect (11).

Administration/toxicity     The lidocaine patch comes as a 10×14 cm adhesive patch containing 700 mg of lidocaine. One to three patches, or only a portion of a patch, can be placed directly over painful areas. It should be placed on intact skin and not surgical wounds or open zoster vesicles. Due to concerns about systemic lidocaine toxicity, up to a maximum of 3 patches applied simultaneously for 12 hours a day has been approved. Onset of analgesia is within a few hours and patients should be able to determine whether the patch is helpful within a week. Some patients find that pain worsens when the patch is off for 12 hours or if it is left on for more than 18 hours, therefore extended dosing has been investigated.  Several pharmacokinetic studies have shown that systemic lidocaine levels remain well within the safe range with doses of up to 4 patches on for 24 hours (12).  Adverse reactions are rare, mild, and mostly topical (rash). The patch is contraindicated in advanced liver failure due to decreased clearance of lidocaine. It is available as a generic in the US, with prices around $50 USD for 30 patches on online discount pharmacies (costplusdrugs.com, pharmacy.amazon.com, queried June 2025), with brand-name prices up to $900 for 30 patches.

Summary     The lidocaine patch 5% is a safe and modestly effective topical analgesic for post-herpetic neuralgia and acute post-operative surgical wound pain. It has not been proven for other pain syndromes, and clinicians should consider reports of its efficacy to be related to placebo mechanisms.

References 

1. Davies PS, Galer BS.  Review of lidocaine patch 5% studies in the treatment of postherpetic neuralgia.  Drugs.  2004; 64:937-947.
2. Gammaitoni AR, Alvarez NA, Galer BS.  Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature.  J Clin Pharmacol. 2003; 43:111-117.
3. Devers A, Galer BS.  Topical lidocaine patch relieves a variety of neuropathic pain conditions:  an open-label study.  Clin J Pain. 2000; 16:205-208.
4. Galer BS, et al.  The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the neuropathic pain scale.  Clin J Pain. 2002; 18:297-301.
5. Tang, J., Zhang, Y., Liu, C. et al. Therapeutic Strategies for Postherpetic Neuralgia: Mechanisms, Treatments, and Perspectives. Curr Pain Headache Rep. 2023; 27: 307–39. https://doi.org/10.1007/s11916-023-01146-x.
6. 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. J Clin Anesth. 2022 Oct; 81:110918. doi: 10.1016/j.jclinane.2022.110918.
7. Ingalls NK, Horton ZA, et al. Randomized, double-blind, placebo-controlled trial using lidocaine patch 5% in traumatic rib fractures. J Am Coll Surg. 2010;210:205-9.
8. Garzón-Rodríguez C, Casals Merchan M, et al. Lidocaine 5 % patches as an effective short-term co-analgesic in cancer pain. Preliminary results. Support Care Ca. 2013; 21:3153-8.
9. 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;12(12):1260-1267.
10. Price R, Smith D, Franklin G, et al. Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary: report of the AAN guideline subcommittee. Neurology. 2022;98(1):31-43.
11. Hashmi JA, Baliki MN, Huang L, et al. Lidocaine patch (5%) is no more potent than placebo in treating chronic back pain when tested in a randomised double blind placebo controlled brain imaging study. Mol Pain. 2012; 8:29.
12. Gammaitoni AR, Davis MW.  Pharmacokinetics and tolerability of lidocaine patch 5% with extended dosing.  Ann Pharm.  2002; 36:236-240.

Version History:  This Fast Fact was originally edited by David E Weissman MD and published in January 2006. Re-copy-edited in April 2009; August 2015; and in June 2025 by Drew A Rosielle MD.
Conflicts of Interest: None to report.