Localized neuropathic pain: an expert consensus on local treatments

Abstract

BackgroundPain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments.Materials and methodsLiterature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice.ResultsSuccessive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously.ConclusionAlthough there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug–drug interactions.

Clinical Manifestation of Acute, Subacute, and Chronic Low Back Pain in Different Age Groups: Low Back Pain in 35,446 Patients

“…This decreased frequency of neuropathic components may be explained by degenerative processes in the intervertebral disc tissue preventing further nerve compression . This finding is in contrast to previous work showing a reduced efficacy of descending inhibitory controls in the elderly, which was interpreted as possibly contributing to a higher frequency of neuropathic pain in the elderly …”

“…44 This finding is in contrast to previous work showing a reduced efficacy of descending inhibitory controls in the elderly, 45 which was interpreted as possibly contributing to a higher frequency of neuropathic pain in the elderly. 46 The literature lacks information about the frequency of neuropathic pain components in elderly LBP patients.…”

Patients’ Global Impression of Change in the management of peripheral neuropathic pain: Clinical relevance and correlations in daily practice

“…In addition, the effectiveness of the patch has been proven in several randomized clinical trials and non‐interventional studies (Backonja et al, ; Clifford et al, ; Hansson, Jensen, Kvarstein, & Strömberg, ; Irving et al, ; Maihofner & Heskamp, ; Mankowski et al, ; Simpson et al, ). Finally, thanks to its low systemic exposure and rapid elimination following application (Pickering, Martin, Tiberghien, Delorme, & Mick, ), few side effects, and in particular cognitive side effects that could interfere with mood or quality of life or lead to premature treatment discontinuation, were expected. It can be hypothesized that AEs following the use of systemic analgesics would have modified the association between PGIC and TSQM measures.…”

Transdermal and Topical Drug Administration in the Treatment of Pain

“…There are several routes of analgesic administration: oral, sublingual, buccal, intranasal, inhaled, subcutaneous, intravenous, intramuscular, rectal, intramedullary, intrathecal, transdermal and topical. Although most patients suffering from pain are treated with analgesics administered by oral and parenteral routes, there is increasing scientific evidence based on well-documented clinical studies that locally administered drugs may be at least as effective as those administered by the oral route [19]. An advantage of the topical route of drug administration is that it has a much better profile for adverse effects because they are designed for local pain treatment with minimal systemic effects.…”