The topical 5% lidocaine medicated plaster in localized neuropathic pain: a reappraisal of the clinical evidence

Abstract

Topical 5% lidocaine medicated plasters represent a well-established first-line option for the treatment of peripheral localized neuropathic pain (LNP). This review provides an updated overview of the clinical evidence (randomized, controlled, and open-label clinical studies, real-life daily clinical practice, and case series). The 5% lidocaine medicated plaster effectively provides pain relief in postherpetic neuralgia, and data from a large open-label controlled study indicate that the 5% lidocaine medicated plaster is as effective as systemic pregabalin in postherpetic neuralgia and painful diabetic polyneuropathy but with an improved tolerability profile. Additionally, improved analgesia and fewer side effects were experienced by patients treated synchronously with the 5% lidocaine medicated plaster, further demonstrating the value of multimodal analgesia in LNP. The 5% lidocaine medicated plaster provides continued benefit after long-term (≤7 years) use and is also effective in various other LNP conditions. Minor application-site reactions are the most common adverse events associated with the 5% lidocaine medicated plaster; there is minimal risk of systemic adverse events and drug–drug interactions. Although further well-controlled studies are warranted, the 5% lidocaine medicated plaster is efficacious and safe in LNP and may have particular clinical benefit in elderly and/or medically compromised patients because of the low incidence of adverse events.

Topic drug therapy for neuropathic pain

“…Most frequent adverse effect was skin rash 47 . Other studies with back pain, carpal tunnel syndrome, osteoarthritis and persistent postoperative chronic pain patients have shown lower pain relief 48 . L5P is not approved for pregnant or puerperal women (lidocaine crosses the placenta and is excreted in the milk) or for children (there are still no studies).…”

The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use

“…This symptom is associated with significant loss of function and reduced quality of life, particularly in the elderly, and is highly resistant to treatment [62, 63]. Although the number of randomized, controlled studies is limited, the efficacy of the 5% lidocaine-medicated plaster in PHN treatment has been demonstrated in many open-label studies and case series, and is well established [1, 2]. …”

“…A later reappraisal of the clinical evidence for using the 5% medicated lidocaine plaster retrieved all relevant efficacy and safety studies (randomized, controlled, or open-label with well-described methodology), case reports and observational studies from a PubMed literature search covering the period from 1960 to September 30, 2015 [2]. Additional references were identified from published articles and the inclusion of studies was based on the methodology used, with large, well-controlled trials using appropriate statistical techniques being preferred [2].…”

“…The 5% lidocaine-medicated plaster has been used for several years to treat localized neuropathic pain (LNP) and reviews of published studies support its use in this indication [1, 2]. Topical application offers a number of advantages over systemic administration.…”

“…A number of researchers and reviewers have recommended the lidocaine plaster as a first-line option for treating LNP [2, 8–15], because the benefit-to-risk ratios are far better than those of systemic analgesic agents [16, 17]. At the present time, the management of patients with neuropathic pain is often inadequate [18, 19], and many patients are not satisfied with their treatment [20, 21].…”