Effectiveness of Lidocaine Plaster for Post-Herpetic Neuralgia
- Report By: Jacob Vander-Starre MD, Jason Seamon DO - Senior EM resident, EM faculty
- Search checked by Jeffrey Jones MD - Research Director
- Institution: Spectrum Health/Michigan State University Emergency Medicine Residency Program
- Date Submitted: 12th June 2018
- Last Modified: 12th June 2018
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Status:
Blue (submitted but not checked)
Three Part Question
In [patients with post-herpetic neuralgia], is [5% lidocaine plaster compared to placebo], more effective in [reducing pain].Clinical Scenario
A 67-year-old female presents with pain in a dermatomal distribution in an area of a healing rash. She was recently diagnosed and treated for Shingles. She would like to avoid oral narcotics and medications that make her “sleepy” and is wondering if there are any effective topical applications.Search Strategy
Medline 1966-05/18 using PubMed, Cochrane Library (2018), and Embase[(exp lidocaine OR exp lignocaine) AND (exp post-herpetic neuralgia)]. Limit to English language.
Search Outcome
227 studies were identified; one systematic review from the Cochrane library addressed the clinical question. This review, published in 2014, considered 6 clinical trials for inclusion. There have not been any further studies published which compared 5% lidocaine plaster to placebo.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Derry S, et al April 2014 England | 12 studies (508 participants) with comparisons with placebo or an active control. Six studies enrolled participants with moderate or severe postherpetic neuralgia | Systematic Review | Patient reported pain relief, withdrawals due to lack of efficacy, adverse events | No high-quality evidence to support the use of topical lidocaine for neuropathic pain, although individual studies and clinical experience indicate that it may be effective. No significant adverse events. | Small sample sizes; high risk of bias both from study design and method of analysis; short duration studies, incomplete outcome data; no pooling of data was possible. |
Comment(s)
Herpes zoster, or shingles, is caused by reactivation of varicella zoster virus, which causes chickenpox. Postherpetic neuralgia is the most common complication, occurring in about one in five patients. It is defined as pain in a dermatomal distribution sustained for at least 90 days after acute herpes zoster. Topical lidocaine is a local anaesthetic available in plasters (or patches), sprays, and creams. The 5% lidocaine-medicated plaster is registered in many countries and clinical guidelines recommend this treatment modality as first or second line therapy for treating postherpetic neuralgia. There is no evidence from good quality randomized controlled studies to support the use of topical lidocaine in postherpetic neuralgia. However, several small individual studies and clinical experience supports efficacy in some patients. Large ongoing studies should provide more robust conclusions about both efficacy and harm. This amount of new data will overwhelm that from studies in this report.Clinical Bottom Line
Topical Lidocaine appears safe and may be effective in the short-term treatment of post-herpetic neuralgia. However there is currently no high-quality evidence to support its routine use.References
- Derry S, Wiffen PJ, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults Cochrane Database of Systematic Reviews 2014; Issue 7. Art. No.: CD010958.