Topical lidocaine

Three studies have evaluated the efficacy of topical lidocaine in patients with PHN [86-88]. Hempenstall and co-authors included only results published in original full communications, whereas Khaliq and co-authors also included a randomized study that had only appeared as an abstract (with added data obtained from the US Food and Drug Administration) [56,60]. Both reviews concluded that topical lidocaine is superior to placebo. Further support for its efficacy comes from a double-blind, vehicle-controlled, two-way, cross-over trial conducted in patients with diverse peripheral neuropathic pains [89]. Of the participants, 55% had PHN. Each treatment arm lasted 7 days and was provided as an add-on to existing medication. Lidocaine plaster was superior to the vehicle patch, with a moderate effect size of 0.4 and an NNT (50%) of 4.4 (95% CI 2.1-17.5) for pain and 8.4 (3.5-a) for allodynia [89]. Lidocaine patches are well tolerated, with local irritation of the skin emerging as the only significant side effect. If not used over broken skin, systemic absorption is considered negligible [60]. The European Federation of Neurological Sciences Task Force recommends lidocaine plasters as the first-line treatment in focal painful neuropathies (such as PHN), and it is licensed for this indication in some European countries [61].

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