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Meta-Analysis
. 2013 Oct 28;2013(10):CD004846.
doi: 10.1002/14651858.CD004846.pub3.

WITHDRAWN: Topical lidocaine for the treatment of postherpetic neuralgia

Waqas Khaliq  1 , Serena Alam, Naveen Kumar Puri
Affiliations
Meta-Analysis

WITHDRAWN: Topical lidocaine for the treatment of postherpetic neuralgia

Waqas Khaliq et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an update of the original Cochrane review published in Issue 2, 2007. The cause of postherpetic neuralgia is damage to peripheral neurons, dorsal root ganglia, and the dorsal horn of the spinal cord, secondary to herpes zoster infection (shingles). In postherpetic neuralgia, peripheral neurons discharge spontaneously and have lowered activation thresholds, and exhibit an exaggerated response to stimuli. Topical lidocaine dampens peripheral nociceptor sensitisation and central nervous system hyperexcitability, and may benefit patients with postherpetic neuralgia.

Objectives: To examine efficacy and safety of topical lidocaine in the treatment of postherpetic neuralgia.

Search methods: We searched the Cochrane Pain, Palliative and Supportive Care Group Trials Register, CENTRAL, MEDLINE, EMBASE, LILACS, SIGLE, Citation Index, the reference lists of all eligible trials, key textbooks, and previous systematic reviews. Last search conducted April 2011.

Selection criteria: Randomised or quasi‐randomised trials comparing topical applications of lidocaine in patients of all ages with postherpetic neuralgia (pain persisting at the site of shingles at least one month after the onset of the acute rash).

Data collection and analysis: Two review authors extracted data, and a third checked them.

Main results: In the original review three studies involving 182 topical lidocaine treated participants and 132 control participants were included. Two studies gave data on pain relief, and the remaining study provided data on secondary outcome measures. The largest study published as an abstract compared topical lidocaine patch to a placebo patch and accounted for 150 of the 314 participants (48%).

A meta‐analysis combining two studies identified a significant difference between topical lidocaine and control groups for the primary outcome measure: a mean improvement in pain relief according to a pain relief scale. Topical lidocaine relieved pain better than placebo (P = 0.003).

There was a statistical difference between the groups for the secondary outcome measure of mean VAS score reduction (P = 0.03), but this was only for a single small study. There were a similar number of adverse skin reactions in both treatment and placebo groups.

The highest recorded blood lidocaine concentration varied between 59 ng/ml and 431 ng/ml between studies. The latter figure is high and the authors of the study suggest that the sample had been contaminated during the assay procedure.

Authors' conclusions: Since the last version of this review in Issue 2, 2007 no new studies have been found and the results therefore remain the same. There is still insufficient evidence to recommend topical lidocaine as a first‐line agent in the treatment of postherpetic neuralgia with allodynia. Further research should be undertaken on the efficacy of topical lidocaine for other chronic neuropathic pain disorders, and also to compare different classes of drugs (e.g. topical anaesthetic applications versus anti‐epileptic drugs).

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Conflict of interest statement

None known

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 Topical lidocaine versus placebo, Outcome 1 Improvement in pain relief according to a pain relief scale.
Analysis 1.2
Analysis 1.2
Comparison 1 Topical lidocaine versus placebo, Outcome 2 Improvement in visual analog scale rating.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Rowbotham MC, Davies PS, Fields HL. Topical Lidocaine Gel relieves post‐herpetic neuralgia. Annals of Neurology 1995;37:246‐53. - PubMed
    1. Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Lidocaine patch: double‐blind controlled study of a new treatment method for post‐herpetic neuralgia. Pain 1996;65:39‐44. - PubMed
    1. Rowbotham MC, Davies PS, Galer BS. Multicenter, double‐blind, vehicle‐controlled trial of long term use of lidocaine patches for post‐herpetic neuralgia (abstract). 8th World Congress on Pain ‐ Abstracts. Seattle: IASP Press, 1996:274.

References to studies excluded from this review

    1. Galer BS, Rowbotham MC, Perander J, Friedman E. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 1999;80:533‐8. - PubMed
    1. Galer B, Jensen M, Ma T, Davies P, Rowbotham M. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomised, double‐blind, vehicle‐controlled, 3‐week efficacy study with the use of the neuropathic pain scale. The Clinical Journal of Pain 2002;18:297‐301. - PubMed
    1. Iseki M, Mitsuhata H, Miyazaki T, Toriumi E, Yoshino K. Relief of subacute herpetic pain and postherpetic neuralgia with repeated application of 10% lidocaine cream. Masui 2000;49(11):1204‐9. - PubMed
    1. Meier T, Wasner G, Faust M, Kuntzer T, Ochsner F, Hueppe M, et.al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomised, double‐blind, placebo‐controlled study. Pain 2003;106:151‐8. - PubMed
    1. Tajti J, Szok D, Vécsei L. Topical acetylsalicylic acid versus lidocaine for postherpetic neuralgia: results of a double‐blind comparative clinical trial. Neurobiology (Budapest) 1999;7(2):103‐8. - PubMed

Additional references

    1. Chidiac C, Bruxelle J, Daures JP, Hoang‐Xuan T, Morel P, Leplege A, et al. Characteristics of patients with herpes zoster on presentation to practitioners in France. Clinical Infectious Diseases 2001;33:62‐9. - PubMed
    1. Cluff RS, Rowbotham MC. Pain caused by herpes zoster infection. Neurologic Clinics 1998;16:813‐32. - PubMed
    1. Comer AM, Lamb HM. Lidocaine patch 5%. Drugs 2000;59:245‐51. - PubMed
    1. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Archives of Internal Medicine 1995;155:1605‐9. - PubMed
    1. Elliot WM, et al. The epidemiology of chronic pain in the community. Lancet 1999;354:1248‐52. - PubMed

References to other published versions of this review

    1. Khaliq W, Alam S, Puri. Topical lidocaine for the treatment of postherpetic neuralgia. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD004846.pub2] - DOI - PubMed

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