PAIN UPDATE
from The Richeimer Pain Institute
February 2000

NEW: LIDOCAINE PATCH 5%

The skin hurts, so numb it.  Logical, but previous efforts with creams and ointments have never worked very well.  A new topical treatment is now available for the difficult problem of postherpetic neuralgia.  The good news is that two placebo-controlled studies in the journal Pain suggest a good response with the Lidocaine patch (Lidoderm, Endo Laboratories), and the patches do appear to be well tolerated..  The bad news is that I suspect that very chronic and severe cases will not respond as well since the pain probably gradually involves more of the central nervous system and less of the periphery.  Nevertheless, the lidocaine patch is a welcome addition to our toolbox and it is intriguing to consider the potential usefulness of lidocaine patches for other chronic pain problems.  This has not yet been explored, but it is high on my list to try.

Application: The patch should be applied only to intact skin, and therefore is specifically for post herpetic rather than acute outbreaks of herpes zoster. The size of the patch is 10 cm x 14 cm, but may be cut into smaller sizes. Up to three patches may be worn simultaneously for twelve-hour periods within a 24-hour period.  

Precautions:  The lidocaine patch should be used with caution in patients receiving class-1 anti-arrhythmic drugs such as tocainide or Mexiletine, even though peak blood levels (with three patches) will only reach one-tenth of therapeutic arrhythmia concentrations. Caution also needs to be used when using this product with patients with severe hepatic disease. Problems with skin irritation appear to be relatively mild and infrequent, and systemic side effects also appear to be relatively rare and mild because of the low levels of systemic absorption.

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Steven Richeimer, MD
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