EMLA cream in the treatment of post-herpetic neuralgia. Efficacy and pharmacokinetic profile

Stow, Peter; Glynn, Chris; Minor, Bruce G.

doi:10.1016/0304-3959(89)90044-4

Cited by 87 publications

(31 citation statements)

References 13 publications

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“…Such formulations are widely used as topical anesthetics for minor acute surgical procedures (Lener et al, 1997), and there are some reports of use in chronic pain conditions such as postherpetic neuralgia (Stow et al, 1989;; but see Devers and Galer, 2000). Clinical attention has focused recently on topical formulations of lidocaine.…”

Section: Local Anestheticsmentioning

confidence: 99%

Topical and Peripherally Acting Analgesics

2003

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Section: Local Anestheticsmentioning

confidence: 99%

Topical and Peripherally Acting Analgesics

2003

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“…19 Oral steroids may add to the benefit of anti-viral therapy for reducing the pain of AHZ but have no effect on the development of PHN. 3 A lidocaine patch 20 and EMLA cream 21 may help in PHN and AHZ. Oral oxycodone, meperidine and methadone all have NMDA-antagonist effects and may treat the acute pain better than other narcotics that do not.…”

Section: Cas No 1 : Une Femme De 79 Ans Porteuse D'une Valvule Mitramentioning

confidence: 99%

Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

Hardy

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : This report describes two cases of acute herpes zoster (AHZ) treated by nerve block resulting in immediate pain relief and possible prevention of post-herpetic neuralgia (PHN).C Cl li in ni ic ca al l f fe ea at tu ur re es s: : Two elderly females with AHZ of cervical dermatomes and severe pain received deep cervical and greater occipital nerve blocks with a local anesthetic, epinephrine and steroid. In both patients, pain resolved immediately and permanently (one year follow-up) after a single treatment.Case #1: A 79-yr-old female with a mechanical mitral valve and anticoagulated with warfarin presented with AHZ of 17 days duration of the right C2, 3, 4 dermatomes and severe pain. A stellate ganglion block was not performed because of anticoagulation. Rather, a deep cervical root block at C3 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. No adverse events were evident. Case #2: A 73-yr-old female with a history of osteoarthritis and Meniere's disease presented with AHZ of seven days duration of the left C2, 3, 4 dermatomes and severe pain. Deep cervical root blocks at C3 and C4 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. Side effects of dizziness, hoarseness, hypertension and Horner's syndrome resolved in a few hours. A mild sensation of itching persisted for two weeks.C Co on nc cl lu us si io on n: : This report illustrates the potential of nerve blocks in severe AHZ to treat acute pain and possibly prevent PHN. Objectif : Décrire deux cas d'herpès zoster aigu (HZA) traités par blocage nerveux résultant en un soulagement immédiat de la douleur et une prévention possible de la névralgie post-herpétique (NPH). Éléments cliniques : Deux femmes âgées souffrant d'HZA des dermatomes cervicaux et de douleurs sévères ont reçu un bloc des nerfs cervical profond et grand occipital avec un anesthésique local, de l'épinéphrine et des stéroïdes. Dans les deux cas, la douleur a été

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“…[38][39][40][41][42][43] In a randomized, placebo-controlled, single-blind study of iontophoresis of vincristine, only minimal benefit was found and all subjects reported burning at electrode sites (class II). 44 Reports of benefit from topical application of lidocaine gel, 45 topical lignocaine/prilocaine cream, 46 intralesional injections of triamcinolone, [47][48][49] and cryocautery with dry ice 50 were limited to class IV studies. Conclusion.…”

Section: R E T I R E D R E T I R E Dmentioning

confidence: 99%

Practice Parameter: Treatment of postherpetic neuralgia: [RETIRED]

Dubinsky¹,

Kabbani²,

Elchami³

et al. 2004

Neurology

267

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Abstract-A systematic review of the literature on postherpetic neuralgia was performed. The authors identified studies using the National Library of Medicine's Medline database and Cochrane Library database. The authors determined absolute reduction rate, number needed to treat (NNT), 95% CI for NNT, and number needed to harm (NNH) for successful therapies of postherpetic neuralgia. Tricyclic antidepressants, gabapentin, pregabalin, opioids, and lidocaine patch were found to be effective in reducing the pain of postherpetic neuralgia. NEUROLOGY 2004;63:959 -965 Acute herpetic neuralgia is characterized as burning, aching, electric shock like pain, or unbearable itching in association with the outbreak of a herpes zoster rash. The pain is associated with dysesthesias, paresthesias, hyperalgesia, hyperesthesia, and allodynia (production of pain by innocuous stimuli).1 The pain may precede the onset of the herpetic rash and, rarely, herpetic neuralgia can occur without the development of a rash.2 Postherpetic neuralgia, persistence of the pain of herpes zoster more than 3 months after resolution of the rash, is relatively common, affecting 10 to 15% of those with herpes zoster. Zoster-associated pain is used to describe the continuum of pain from acute herpes zoster to the development of postherpetic neuralgia. The time interval used in the clinical case definition of postherpetic neuralgia varies in the literature from 1 to 6 months after resolution of the rash. The incidence of postherpetic neuralgia increases with age. 3 The duration of postherpetic neuralgia is highly variable. In a longitudinal study, of those who developed postherpetic neuralgia, only 48% were symptomatic 1 year after onset.4,5 A prospective study of postherpetic neuralgia, performed through a network of primary care providers in Iceland from 1990 to 1995, showed that 14 of the 25 who developed postherpetic neuralgia were symptomatic 12 months after onset.6 Thus, the natural history of resolution of postherpetic neuralgia over time is a confounder in the evaluation of treatment efficacy and may limit the ability to generalize the results of controlled clinical trials in this population.Administration of antiviral agents within 72 hours of the onset of herpes zoster can reduce the intensity and duration of acute illness, and can prevent postherpetic neuralgia, 7 as may the use of amitriptyline.8 Efforts at prevention of herpes zoster and postherpetic neuralgia are important in that 40 to 50% of those with postherpetic neuralgia do not respond to any treatment. 9 The treatment of acute herpes zoster 10 and the prevention of postherpetic neuralgia are beyond the scope of this parameter.This practice parameter was developed to answer the following clinical question: In patients with postherpetic neuralgia, which treatments provide benefit in terms of decreased pain and improved quality of life?Process. We searched the National Library of Medicine's Medline database and the Cochrane database for peer-reviewed articles published between

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EMLA cream in the treatment of post-herpetic neuralgia. Efficacy and pharmacokinetic profile

Cited by 87 publications

References 13 publications

Topical and Peripherally Acting Analgesics

Topical and Peripherally Acting Analgesics

Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

Practice Parameter: Treatment of postherpetic neuralgia: [RETIRED]

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