Poststroke pain syndrome is commonly regarded as an intractable disease. We describe four patients who responded to an intravenous lidocaine infusion for relief of central pain after a stroke. The infusion was administered over a 48-hour period after an initial bolus of 50 to 100 mg intravenously over 40 to 120 seconds. Pain intensity and pain relief were measured by visual analog and numeric scales. All patients reported some relief within the first 12 hours of infusion. All patients were subsequently given a trial of mexiletine, an oral congener of lidocaine. Two have continued taking the drug and report excellent relief at 12 months' follow-up; the other two had side effects that precluded further use of the drug. We conclude that lidocaine can reduce poststroke pain, and we propose a treatment algorithm based on our experience with 40 additional patients treated for other neuropathic pain states.