Can you get addicted from using topical or local anaesthetics to ease pain?

Question

I've been wondering if there was such a thing as developing some kind of physical or psychological dependence on things that relieve pain. While we often hear about opioid addiction, which is primarily physical, I wonder if someone could psychologically be hooked on using something like lidocaine to numb every bruise or injury they get, just to numb the pain.

I did hear that cocaine was once used as an anaesthetic, but it was also physically addicting. This makes me wonder if physical withdrawal and hunger cravings are similar.

Answer 1

Short answer
Basing an answer strictly on the DSM-V criteria, local anesthetics may, purely hypothetically, be associated with a mild form of addiction. But realistically, I think it is unlikely that a person (ab)using a topical anesthetic will ever be medically diagnosed as having a substance abuse disorder.

Background
I think the question hinges on the definition of [drug] addiction. The APA addresses addiction in DSM-V by the following criteria (entered in shortened form for brevity):

A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe [...]

1. Taking the opioid in larger amounts and for longer than intended
2. Wanting to cut down or quit but not being able to do it
3. Spending a lot of time obtaining the opioid
4. Craving or a strong desire to use opioids
5. Repeatedly unable to carry out major obligations at work, school, or home [...]
6. Continued use despite [...] social or interpersonal problems [...]
7. Stopping or reducing important social, occupational, or recreational activities [...]
8. Recurrent use of opioids in physically hazardous situations
9. Consistent use of opioids despite [...] physical or psychological difficulties [...]
10. [Development of t]olerance [...]
11. [Development of w]ithdrawal [symptoms]

In contrast to opiates, lidocaine has no rewarding or addictive properties. As a result, lidocaine can be used systemically and on a long-term basis for the treatment of chronic pain (Yousefshahi et al., 2017). In fact, lidocaine, has equally effective anelgesic effects in people addicted to opioids as in normal controls (Hashemian et al., 2013). Because lidocaine is a local anesthetic without central effects, and taken together with above findings, we can safely rule out the occurrence all of the criteria except, perhaps, the first three. Those first three may be, at least hypothetically, possible when topical or systemic application relieves some sort of untolerable pain. Given that meeting 3 criteria meets the definition of a mild substance abuse disorder (mild addiction), I wouldn't rule addiction to topical anesthetics out completely. It does seem unlikely, though.

Cocaine has strong addicitve effects, because of it's pronounced effects in the central nervous system - it is associated with strong feelings of reward and euphoria. It rapidly induces tolerance as well as dependence; a school book example of a substance of abuse. Lidocaine is a cocaine derivative that still exhibits its anelgesic properties, without its psychoactive component (Small, 2009).

<sub>References
- Hashemian et al., J Emerg Trauma Shock (2014); 7(4): 301–4
- Small, Subst Use Misuse (2009); 44(13): 1888-98
- Yousefshahi et al., Anesth Pain Med (2017); 7(3): e44732</sub>

Answer 2

I've been wondering if there was such a thing as developing some kind of physical or psychological dependence on things that relieve pain.

Yes. However:

You need to be careful about your use of the word pain: opioids are analgesics, they relieve the subjective experience of pain. They're addictive.

Lignocaine is a local anaesthetic: it prevents nociception or the sensory input that indicates the presence of a noxious stimulus. This in turn renders the relief of any pain unnecessary.

More broadly, however, I was going to suggest that people can become addicted to unpleasant things, not because the unpleasant this is pleasant per se, but because the removal of said unpleasantness is relieving.

A little tangential, but may be worth a read: Are nonpharmacological induced rewards related to anhedonia? A study among skydivers

While we often hear about opioid addiction, which is primarily physical,

This is where you've lost me. While opioid dependency is definitely characterised by physical features e.g. withdrawal syndrome, I think it's very inaccurate to consider it purely a "physical" dependency. If this were the case, then following a prolonged period of abstinence, there would be no concern of relapse -- the once dependent individual has no "physical addiction" to opioids to speak of.

If you would like to know the difference between "physical" dependency to opioids and "physical and psychological" dependency to opioids, I would suggest the following treatment schedule:

1. Take the OTC medication loperamide, which is an opioid agonist that cannot cross the BBB.

2. 1 week washout

3. Take heroin every 8 hours for two weeks

4. 1 week washout

5. Report back if you noticed a difference between heroin and loperamide.

I wonder if someone could psychologically be hooked on using something like Lidocaine to numb every bruise or injury they get just to numb the pain.

Yes, but not for the reasons you are thinking.

Local anaesthetics act locally, and are the functional equivalent of a reversible lesion to the nerves they are acting on. Anything that an individual finds pleasant can become "addicting", but with respect to lignocaine, it's prudent to note that if it were addictive, it would have nothing to do with any action centrally.

I did hear that cocaine was once used as an anaesthetic, but it was also physically addicting.

Cocaine is still used in ENT surgery, as it is an highly effective vasoconstricting agent.

Its addictive properties, however, are largely thought to be limited to the "psychological" space. Yes, I state that in full appreciation for the above regarding physical. This is not to say that an individual does not have "physical symptoms" e.g. tiredness, but that these symptoms have a locus somewhere in the brain.

This makes me wonder if physical withdrawal and hunger cravings are similar.

One concept in neuroscience/neuropsychology is the somatic marker hypothesis by Dimasio, which proposes that our behaviours/decisions are effectively guided by somatic, or physical sensations that are strongly linked to our emotions.

Thus, the body's need for food would instantiate a physiological state of discomfort that drives us behaviourally to seek food.

Likewise, the body's need for more IV heroin, would evince its own set of "somatic markers" likely to guide one's own behaviour towards the acquisition of more intravenous heroin.

See below:

The somatic marker hypothesis: A neural theory of economic decision

Modern economic theory ignores the influence of emotions on decision-making. Emerging neuroscience evidence suggests that sound and rational decision making, in fact, depends on prior accurate emotional processing. The somatic marker hypothesis provides a systems-level neuroanatomical and cognitive framework for decision-making and its influence by emotion. The key idea of this hypothesis is that decision-making is a process that is influenced by marker signals that arise in bioregulatory processes, including those that express themselves in emotions and feelings. This influence can occur at multiple levels of operation, some of which occur consciously, and some of which occur non-consciously. Here we review studies that confirm various predictions from the hypothesis, and propose a neural model for economic decision, in which emotions are a major factor in the interaction between environmental conditions and human decision processes, with these emotional systems providing valuable implicit or explicit knowledge for making fast and advantageous decisions.