Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
Abstract
Abstracts
Brief Communication
Case Report
Case Series
Commentary
Conference Abstract
Conference Editorial
Conference Proceedings
Current Issue
Editorial
Editorial Commentary
Erratum
IAPCONKochi 2019 Conference Proceedings
Letter to Editor
Letter to the Editor
Letters to Editor
Narrative Review
Original Article
Personal Reflection
Perspective
Perspectives
Position Paper
Position Statement
Practitioner Section
Report
REPUBLICATION: Special Article (Guidelines)
Review Article
Short Communication
Special Editorial
Special Review
Systematic Review
View/Download PDF

Translate this page into:

Letters to Editor
25 (
4
); 594-595
doi:
10.4103/IJPC.IJPC_99_19

Lidocaine 5% Patch in Localized Neuropathic Pain

Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
Address for correspondence: Dr. Abhijit S Nair, Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad - 500 034, Telangana, India. E-mail: abhijitnair95@gmail.com
Licence

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Disclaimer:
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher; therefore Scientific Scholar has no control over the quality or content of this article.

Sir,

The International Association for the Study of Pain has defined neuropathic pain (NP) as “pain caused by a lesion or disease of the somatosensory nervous system.”[1] Pathophysiology of NP involves both peripheral and central mechanisms. Localized NP is a distinct entity which is seen in a lot of conditions. Localized NP is characterized by consistent and circumscribed areas of pain associated with negative or positive sensory signs and/or spontaneous symptoms characteristic of NP.[2] It could be due to infectious, metabolic, postoperative, nerve entrapment or compression, and chemotherapy induced.[3] Table 1 shows the situations causing commonly encountered localized NP. In this condition, there is neuronal hyperexcitability due to plastic changes in afferent nociceptive fibers from peripheral and central nerves. There is also central sensitization and hyperexcitation of spinal nociceptive neurons leading to increase in spontaneous discharge along with impairment of modulatory descending inhibitory controls. Routinely used medications for NP such as antidepressants, antiepileptics, and opioids usually do not provide effective relief in localized NP. On the other hand, patients suffer with unwanted adverse effects due to the use of above-mentioned medications, especially elderly patients and patients with medical comorbidities. In resistant situations, 5% lidocaine and 8% capsaicin transdermal patches have been used successfully. Although lidocaine 5% patch has been used in many localized NP, 8% capsaicin has been found beneficial only in postherpetic neuralgia (PHN) and NP due to HIV.[4]

Table 1: Causes of localized neuropathic pain with examples
Cause of localized neuropathic pain Examples
Infectious disease PHN and AIDS
Metabolic Diabetic polyneuropathy
Toxic Alcoholic neuropathy
Vitamin deficiency B12 deficiency
Postoperative Thoracotomy, mastectomy, cesarean section, head-and-neck cancer surgeries, and posthernioplasty
Nerve entrapment Carpal tunnel syndrome
Cancer chemotherapy Vinca alkaloids, taxanes, and platinum compounds
Miscellaneous Complex regional pain syndrome 1 and radiculopathies

PHN: Postherpetic neuralgia

When used as a patch, lidocaine nonselectively blocks sensory afferents of small damaged pain fibers, thus reducing ectopic discharge and signal propagation. Lidocaine patch does not lead to a sensory block due to blockade of Na+ channels present on large myelinated Aβ sensory fibers. The patch has a negligible or no systemic absorption after application (3%–5%) usually gets systemically absorbed which is negligible. Till date, local anesthesia systemic toxicity has not been reported with lidocaine patch. Therefore, dose adjustment is not required in patient with mild-to-moderate renal and hepatic impairments. Commonly encountered adverse effects with routinely used chronic NP medications such as sedation, constipation, and cognitive dysfunction can totally be avoided with the use of patches. Some patients do complain erythema, itching, burning, and edema at the site of application, but it is self-limiting and resolves once the patch is removed. The patch should be preferably avoided in infected, atrophic, and injured skin. Long-term use of 5% lidocaine patch has been established, especially in patients with PHN, postoperative pain, and in complex regional pain syndrome-1 (up to 3–5 years).[5]

Although lidocaine patch has shown efficacy in certain category of patients, there is no robust evidence from good quality randomized controlled studies to justify the use of lidocaine patch to treat all categories of localized NP.[6] Right now, the use of patch is not recommended in pregnancy and children.

To conclude, the lidocaine patch is a reasonable alternative in patients with localized NP as mentioned earlier. It is devoid of adverse effects which are observed with routinely used oral medications, is safe, well tolerated, and can be used for a long duration. It can be used along with other systemic medications also.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

  1. International Association for the Study of Pain. IASP Taxonomy. Pain Terms. Neuropathic Pain. Available from: http://www.iasp pain.org/Taxonomy#Neuropathicpain
    [Google Scholar]
  2. , , , , , , . What is localized neuropathic pain. A first proposal to characterize and define a widely used term? Pain Manag. 2012;2:71-7.
    [Google Scholar]
  3. , , , , , . Localized neuropathic pain: An expert consensus on local treatments. Drug Des Devel Ther. 2017;11:2709-18.
    [Google Scholar]
  4. , , . Profile of the capsaicin 8% patch for the management of neuropathic pain associated with postherpetic neuralgia: Safety, efficacy, and patient acceptability. Patient Prefer Adherence. 2016;10:1913-8.
    [Google Scholar]
  5. , , , , , . Long-term treatment of neuropathic pain with a 5% lidocaine medicated plaster. Eur J Anaesthesiol. 2010;27:169-73.
    [Google Scholar]
  6. , , , , . Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev. 2014;7:CD010958.
    [Google Scholar]
Show Sections