The local anesthetic lidocaine is increasingly used systemically for the treatment of neuropathic pain. Benefits for other pain conditions are less consistently observed, and most clinical reports are from small or poorly-controlled trials. Considered to act primarily as an antagonist of sodium channels, recent evidence suggests that several other mechanisms may contribute to the analgesic effect of lidocaine and its active metabolites. In properly screened patients, short intravenous infusions of doses of lidocaine are well tolerated without continuous monitoring of the ECG. Continuous infusions of lidocaine administered over 3–5 days may provide more durable pain control than intermittent, short infusions.