Treatment of postoperative localized neuropathic pain with topical 5% lidocaine. Case report
Tratamento de dor neuropática pós-operatória localizada com lidocaína tópica a 5%. Relato de caso
André Liggieri; Fabíola Minson; Mariana Palladini
Abstract
BACKGROUND AND OBJECTIVES: Post-surgical neuropathic pain (NP) is an important clinic condition, with recurring pain and that may be a result of transection, contusion, nerve inflammation or stretching and lasting for 3-6 months. Having into consideration the prevalence of postoperative localized NP, its impact in quality of life of patients, its complexity of diagnosis and treatment and available treatment options, the aim of this report was to present efficacy, safety and tolerability outcomes of 5% lidocaine transdermal patch use as a single treatment or in combination with other therapeutic options by describing and analyzing four clinical cases.
CASES REPORT: Four patients aged between 43 and 70 years old and complains of postoperative localized NP were managed with 5% lidocaine transdermal patch in prolonged treatment, with significant improvement in pain scores.
CONCLUSION: The outcomes of the described cases revealed that postoperative localized NP management was successful with 5% lidocaine transdermal patch. Moreover, it was possible to observe that its association to other treatments (pharmacological or not) has proved efficacy with no negative impact the tolerability of the treatment or the patient routine and comfort.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A dor neuropática (DN) pós-operatória é um problema clínico relevante, com dor persistente, que pode ser resultado de transecção, contusão, alongamento ou inflamação do nervo, durando geralmente cerca de 3-6 meses após a cirurgia. Tendo em consideração a prevalência estimada da DN localizada pós-operatória, seu impacto na qualidade de vida dos pacientes, sua complexidade diagnóstica e terapêutica, e as opções de tratamento disponíveis, o presente estudo teve como objetivo apresentar os desfechos de eficácia, segurança e tolerabilidade do uso do emplastro de lidocaína a 5% nesta condição clínica, seja como fármaco isolado ou em combinação com outras classes terapêuticas.
RELATO DOS CASOS: Quatro pacientes com idades entre 43 e 70 anos e com história de DN localizada pós-operatória foram manejados com emplastro de lidocaína a 5% em tratamento prolongado, com melhora significativa do nível de dor.
CONCLUSÃO: Os resultados dos casos apresentados neste estudo revelam que o manejo da DN localizada pós-operatória foi eficaz com a utilização do emplastro de lidocaína a 5%. Além disso, foi possível observar que sua associação com outros tratamentos (farmacológicos ou não) mostrou-se efetiva, sem impactar negativamente a tolerabilidade do tratamento ou o conforto do paciente.
Palavras-chave
References
1 Staff NP, Engelstad J, Klein CJ, Amrami KK, Spinner RJ, Dyck PJ, Warner MA, Warner ME, Dyck PJ. Post-surgical inflammatory neuropathy. Brain. 2010;133(10):2866-80.
2 Prudhomme M, Legras A, Delorme C, Lansaman T, Lanteri-Minet M, Medioni J, Navez M, Perrot S, Pickering G, Serrie A, Viel E. Management of neuropathic pain induced by surgery: review of the literature by a group of experts specialized in pain management, anesthesia and surgery. J Visc Surg. 202;157(1):43-52.
3 Dualé C, Ouchchane L, Schoeffler P; EDONIS Investigating Group, Dubray C. Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up. J Pain. 2014;15(1):24.e1-20. 4.
4 Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, Kranke P, Komann M, Lehman T, Meissner W; euCPSP group for the Clinical Trial Network group of the European Society of Anaesthesiology. Chronic postsur-gical pain in Europe: an observational study. Eur J Anaesth. 2015;32(10):725-34.
5 Plancarte-Sánchez R, Samano-García M, Guillén-Núñez MDR, Equihua-Ortega A. Localized neuropathic pain. Gac Med Mex. 2021;157(3):302-8.
6 Mick G, Baron R, Correa-Illanes G, Hans G, Mayoral V, Frías X, Sintes D, Keller T. Is an easy and reliable diagnosis of localized neuropathic pain (LNP) possible in general practice? Development of a screening tool based on IASP criteria. Curr Med Res Opin. 2014;30(7):1357-66.
7 Mayoral V, Pérez-Hernández C, Muro I, Leal A, Villoria J, Esquivias A. Diagnostic accuracy of an identification tool for localized neuropathic pain based on the IASP criteria. Curr Med Res Opin. 2018;34(8):1465-73.
8 Vranken JH. Mechanisms and treatment of neuropathic pain. Cent Nerv Syst Agents Med Chem. 2009;9(1):71-8.
9 Pickering G, Martin E, Tiberghien F, Delorme C, Mick G. Localized neuropathic pain: an expert consensus on local treatments. Drug Des Devel Ther. 2017;11:2709-18.
10 Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-73.
11 Allegri M, Baron R, Hans G, Correa-Illanes G, Mayoral Rojals V, Mick G, Serpell M. A pharmacological treatment algorithm for localized neuropathic pain. Curr Med Res Opin. 2016;32(2):377-84.
12 Moisset X, Bouhassira D, Avez Couturier J, Alchaar H, Conradi S, Delmotte MH, Lanteri-Minet M, Lefaucheur JP, Mick G, Piano V, Pickering G, Piquet E, Regis C, Salvat E, Attal N. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol (Paris). 2020;176(5):325-52.
13 Sawynok J. Topical analgesics for neuropathic pain: preclinical exploration, clinical validation, future development. Eur J Pain. 2014;18(4):465-81.
14 Correa-Illanes G, Calderón W, Roa R, Piñeros JL, Dote J, Medina D. Treatment of localized post-traumatic neuropathic pain in scars with 5% lidocaine medicated plaster. Local Reg Anesth. 2010;3(1):77-83.
15 Sansone P, Passavanti MB, Fiorelli A, Aurilio C, Colella U, De Nardis L, Donatiello V, Pota V, Pace MC. Efficacy of the topical 5% lidocaine medicated plaster in the treatment of chronic post-thoracotomy neuropathic pain. Pain Manag. 2017;7(3):189-96.
16 de León-Casasola OA, Mayoral V. The topical 5% lidocaine medicated plaster in localized neuropathic pain: a reappraisal of the clinical evidence. J Pain Res. 2016;9(1):67-79.
17 Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352(13):1324-34.
18 Casale R, Di Matteo M, Minella CE, Fanelli G, Allegri M. Reduction of painful area as new possible therapeutic target in post-herpetic neuropathic pain treated with 5% lidocaine medicated plaster: a case series. J Pain Res. 2014;7:353-7.
19 Santos JG, Brito JO, de Andrade DC, Kaziyama VM, Ferreira KA, Souza I, Teixeira MJ, Bouhassira D, Baptista AF. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain. 2010;11(5):484-90.
20 Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, Werthmann PG, Moher D, Rison RA, Shamseer L, Koch CA, Sun GH, Hanaway P, Sudak NL, Kaszkin-Bettag M, Carpenter JE, Gagnier JJ. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017 May 18. pii: S0895-4356(17)30037-9.
21 Uberall MA, Muller-Schwefe GH. Patient perceptions associated with the 5% lidocaine-medicated plaster in daily practice. Curr Med Res Opin. 2012;28(6):901-9.
22 Baron R, Allegri M, Correa-Illanes G, Hans G, Serpell M, Mick G, Mayoral V. The 5% Lidocaine-medicated plaster: its inclusion in international treatment guidelines for treating localized neuropathic pain, and clinical evidence supporting its use. Pain Ther. 2016;5(2):149-69.
23 Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. 1998;280(21):1837-42.
24 Davies PS, Galer BS. Review of lidocaine patch 5% studies in the treatment of postherpetic neuralgia. Drugs. 2004;64(9):937-47.
Submitted date:
08/08/2022
Accepted date:
03/27/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
Email