Treatment of Neuropathic Pain

Kristen Jefferies, Pharm.D.

Disclosures

Semin Neurol. 2010;30(4):425-432. 

In This Article

Topical Lidocaine

Topical lidocaine is thought to reduce discharges of small afferent nerve fibers by blocking voltage-gated sodium channels.[3] It is available in gel and transdermal patch formulations. The transdermal patch is FDA approved for treatment of PHN.[14]

Lidocaine 5% transdermal patch was effective in randomized controlled trials of patients with allodynia due to PHN or peripheral neuropathies of other etiologies.[6] A lidocaine gel formulation was effective in patients with PHN and allodynia, but can also be considered when the transdermal patch is not available, is not tolerated, or is too expensive.[5] NeuPSIG recommends topical lidocaine as a first-line option for the treatment of localized peripheral neuropathic pain,[5] and the EFNS recommends it as first-line treatment of PHN with allodynia. Topical lidocaine is considered a second-line treatment option for localized neuropathic pain by the CPS.[4]

A maximum of three patches can be applied to the painful area once every 24 hours and left in place for 12 hours. Prior to removing the release liner, the patches can be cut to fit the affected area.[14] Topical lidocaine is well tolerated and minimal systemic absorption occurs at the recommended dose.[5] No dose titration is necessary to reach an effective dose.[6]

Lidocaine patches are effective only for the area where the patch is applied, and are not helpful for central neuropathic pain or to treat polyneuropathy that occurs over a large area.[6] Application site irritation may occur. Although systemic absorption is unlikely, topical lidocaine should be used with caution in patients with hepatic dysfunction, and those taking class I antiarrhythmic medications such as mexiletine.[5] Increased absorption or drug accumulation may occur when the patch is applied for longer periods of time or over larger areas than recommended, in small patients, and in patients with kidney insufficiency.[14]

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