Use of lidocaine patches for neuropathic pain in a comprehensive cancer centre.
BACKGROUND
There are few reports of the use of the lidocaine 5% patch (L5%P) for neuropathic pain (NP) in the cancer patient. Within a comprehensive cancer centre, L5%P has been prescribed by the Pain and Palliative Care Service (Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia) for selected patients with NP since 2001.


OBJECTIVE
To retrospectively audit the use of L5%P within a comprehensive cancer centre.


METHODS
All L5%P prescriptions up to January 2009 were listed and patient medical records were searched to determine neuropathic pain syndromes treated, the presence of allodynia, previous analgesic medications, treatment duration and outcome.


RESULTS
L5%P was prescribed for 97 patients, most frequently for persistent postsurgical NP (n=26), postherpetic neuralgia (n=24) and cancer-related NP (n=18). Six patients had no history of cancer and two patients never applied L5%P. Reviewers classed L5%P analgesic efficacy as 'potent' in 38% of patients with postherpetic neuralgia, 35% of patients with postsurgical pain, 27% of patients with NP after other treatments for cancer and 12% of patients with NP attributed to cancer alone. Allodynia featured in at least 60% of patients. Where allodynia was present, the efficacy of L5%P was assessed as 'potent' in 38% and 'partial' in 24%, but 'ineffective' in 26%, and 'causing worse pain' in 3.4% of patients. Treatment duration extended longer than one month in 52 patients, longer than two months in 29 patients and longer than one year in 13 patients. Therapy was ceased due to skin irritation in seven patients. The outcomes in relation to other reports are discussed.


CONCLUSIONS
The present data support trials of L5%P for cancer patients with NP syndromes associated with allodynia.
Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. Julia_Fleming@health.qld.gov.au
Julia Ann
JA
Fleming
Bradley David
BD
O'Connor
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy / Q000209:etiology; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000187:drug effects; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine