Get access

Topical lidocaine for the treatment of postherpetic neuralgia

  • Review
  • Intervention

Authors


Anna Hobson, Cochrane Pain, Palliative & Supportive Care Group, Pain Research Unit, The Churchill Hospital, Old Road, Oxford, OX3 7LE, UK. anna.hobson@ndcn.ox.ac.uk.

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).

摘要

背景

局部麻醉藥lidocaine 用來治療皰疹後神經痛

皰疹後神經痛的起因是因為感染herpes zoster(帶狀皰疹),因而對周邊神經元、背部神經節和脊髓的背部神經的損傷。皰疹後神經痛,周邊神經元自發性的放電和降低閾值活性,然後表現出對刺激產生一個較大的反應。局部麻醉藥lidocaine 抑制周邊痛覺接受器和中樞神經系統過度激發性,對於因皰疹後神經痛的患者也許是有幫助的。

目標

來檢視局部麻醉藥lidocaine 對皰疹後神經痛患者的治療效果和安全性。

搜尋策略

我們搜尋了Cochrane Pain, Palliative and Supportive Care Group Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS, SIGLE for conference proceedings, Citation Index,所有適合的試驗、關鍵參考書目和之前已發表的系統性回顧。我們並寫信給所有上述試驗的作者。

選擇標準

以隨機化的或quasi隨機的試驗來比較所有使用局部麻醉藥lidocaine,包括以膠凝和貼片,用在皰疹後神經痛(在開始發生急性紅疹後疼痛在皰疹的部位持續至少一個月以上)的所有年齡層患者身上。

資料收集與分析

二位回顧作者擷取了資料,並且由第三位作者做檢查。我們並獲得了一些從美國食品與藥物管理局所漏掉的資料。

主要結論

三個試驗包含182位接受局部麻醉藥lidocaine的受試者和132位控制組的受試者。二個試驗給了關於疼痛緩解的資料,而剩餘研究提供了在次發性結果的資料。已發表中最大的試驗是比較的局部麻醉藥lidocaine的貼片和安慰劑的貼片,在314名患者中的150位(48%)是有效的。一個整合分析結合三個研究中的兩個,根據原始的結果顯示了在使用局部麻醉劑lidocaine和控制組間有明顯的結果差異:以疼痛指標來顯示疼痛的程度是有明顯的改善。局部麻醉藥lidocaine 解輕疼痛是比用安慰劑好的(P值 = 0.003)。在兩組之間平均疼痛指標的下降結果也是有統計上的差異(P = 0.03), 但這是只是一個單一較小型的試驗。在皮膚不良反應中,兩組是差不多的。在這些試驗中血液lidocaine 最高濃度的變化在59 ng/ml和431 ng/ml。後面圖中濃度較高,而此研究的作者們認為是因為樣品在分析期間被污染了。

作者結論

沒有足夠證據來顯示局部麻醉藥lidocaine 在皰疹後神經痛的治療與抗異處疼痛作為第一線用藥。進一步的研究應該實施針對在局部麻醉藥lidocaine治療其它慢性神經病變性疼痛的效力,並和不同類型藥物來作比較(比方說局部麻醉藥和對抗癲癇藥物的比較)。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

局部麻醉藥lidocaine也許以對於一些患者是有幫助的,但是有更強的證據使用其它藥物更有幫助。皰疹後神經痛是一個長期的疼痛疾病,對正常的刺激也會產生疼痛。局部麻醉藥(譬如lidocaine) 能減少透過神經傳導的疼痛感,同時使皰疹後神經痛患者的疼痛緩解。這項回顧發現三個小型的研究包含182個接受局部麻醉藥lidocaine治療的受試者和132個控制組的受試者使用安慰劑來治療皰疹後神經痛。二項研究資料顯示在皰疹後神經痛的患者有疼痛緩解,並且他們表示了使用局部麻醉藥lidocaine 與安慰劑來比較疼痛有一些改善。但是未與目前其他治療皰疹後神經痛的藥物做比較。局部麻醉藥lidocaine 的副作用是非常最小的,但是包括皮膚問題(譬如刺激和潮紅)。我們無法推薦使用局部麻醉藥lidocaine來做為皰疹後神經痛的第一線治療用藥。需要進一步的研究來比較局部麻醉lidocaine 與其它藥物在皰疹後神經痛的治療效果。

Plain language summary

Topical lidocaine (a local anaesthetic) for the treatment of postherpetic neuralgia (nerve pain)

Topical lidocaine may benefit some patients on an individual basis though there is stronger evidence for the use of other drugs. Postherpetic neuralgia is a long-lasting pain disorder that causes pain from stimuli that are not normally painful. Local anaesthetics (such as lidocaine) can reduce the sensation of pain that is transmitted through nerves, and allow pain relief in patients with postherpetic neuralgia. This review found three small studies involving 182 topical lidocaine treated participants and 132 control participants using lidocaine for patients with postherpetic neuralgia. Two studies provided data on pain relief amongst patients with postherpetic neuralgia, and they showed some improvement in pain when topical lidocaine was compared to a placebo. No comparison was made with other medications that are in current use for the treatment of postherpetic neuralgia. The side effects of topical lidocaine are very minimal, but include skin problems (such as irritation and redness). We are unable to recommend the use of topical lidocaine as a first-line treatment for postherpetic neuralgia at this stage. Further studies are needed to compare topical lidocaine to other medications in the treatment of postherpetic neuralgia.

Get access to the full text of this article

Ancillary