Localized neuropathic pain: an expert consensus on local treatments

Gisèle Pickering, Elodie Martin, Florence Tiberghien, Claire Delorme, Gérard Mick, Gisèle Pickering, Elodie Martin, Florence Tiberghien, Claire Delorme, Gérard Mick

Abstract

Background: Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments.

Materials and methods: Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice.

Results: Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously.

Conclusion: Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug-drug interactions.

Keywords: localized; medicated plaster; neuropathic pain; patch; review; topical.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Treede R-D, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630–1635.
    1. IASP [webpage on the Internet] Taskforce on Taxonomy. 2011. [Accessed July 5, 2017]. [cited Nov 15, 2016]. Available from: .
    1. Morel V, Joly D, Villatte C, et al. Memantine before mastectomy prevents post-surgery pain: a randomized, blinded clinical trial in surgical patients. PLoS One. 2016;11(4):e0152741.
    1. Pickering G, Gavazzi G, Gaillat J, Paccalin M, Bloch K, Bouhassira D. Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month longitudinal prospective observational ARIZONA cohort study. BMJ Open. 2016;6(2):e009689.
    1. Gavazzi G, Herpes Zoster and Functional Decline Consortium. Pickering G, Schmader K. Functional decline and herpes zoster in older people: an interplay of multiple factors. Aging Clin Exp Res. 2015;27(6):757–765.
    1. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008;136(3):380–387.
    1. Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol. 2006;4(3):175–181.
    1. Brown MR, Ramirez JD, Farquhar-Smith P. Pain in cancer survivors. Br J Pain. 2014;8(4):139–153.
    1. Mick G, Correa-Illanes G. Topical pain management with the 5% lidocaine medicated plaster – a review. Curr Med Res Opin. 2012;28(6):937–951.
    1. Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007;132(3):237–251.
    1. van Hecke O, Kamerman PR, Attal N, et al. Neuropathic pain phenotyping by international consensus (NeuroPPIC) for genetic studies: a NeuPSIG systematic review, Delphi survey, and expert panel recommendations. Pain. 2015;156(11):2337–2353.
    1. Deng Y, Luo L, Hu Y, Fang K, Liu J. Clinical practice guidelines for the management of neuropathic pain: a systematic review. BMC Anesthesiol. 2016;16:12.
    1. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173.
    1. Mick G, Baron R, Finnerup NB, et al. What is localized neuropathic pain? A first proposal to characterize and define a widely used term. Pain Manag. 2012;2(1):71–77.
    1. Casale R, Symeonidou Z, Bartolo M. Topical treatments for localized neuropathic pain. Curr Pain Headache Rep. 2017;21(3):15.
    1. Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;5:CD008609.
    1. Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain. 2004;5(3):143–149.
    1. Yawn BP, Wollan PC, Weingarten TN, Watson JC, Hooten WM, Melton LJ. The prevalence of neuropathic pain: clinical evaluation compared with screening tools in a community population. Pain Med. 2009;10(3):586–593.
    1. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92(1–2):147–157.
    1. Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005;6(3):149–158.
    1. Fine PG. Chronic pain management in older adults: special considerations. J Pain Symptom Manage. 2009;38(2 suppl):S4–S14.
    1. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807–819.
    1. 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.e1–24.e20.
    1. Golan-Vered Y, Pud D. Chemotherapy-induced neuropathic pain and its relation to cluster symptoms in breast cancer patients treated with paclitaxel. Pain Pract. 2013;13(1):46–52.
    1. Kohama I, Ishikawa K, Kocsis JD. Synaptic reorganization in the substantia gelatinosa after peripheral nerve neuroma formation: aberrant innervation of lamina II neurons by Abeta afferents. J Neurosci. 2000;20(4):1538–1549.
    1. Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain. 1991;44(3):293–299.
    1. Pickering G, Pereira B, Dufour E, Soule S, Dubray C. Impaired modulation of pain in patients with postherpetic neuralgia. Pain Res Manag. 2014;19(1):e19–e23.
    1. Bannister K, Patel R, Goncalves L, Townson L, Dickenson AH. Diffuse noxious inhibitory controls and nerve injury: restoring an imbalance between descending monoamine inhibitions and facilitations. Pain. 2015;156(9):1803–1811.
    1. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010;120(11):3760–3772.
    1. Marwaha L, Bansal Y, Singh R, Saroj P, Bhandari R, Kuhad A. TRP channels: potential drug target for neuropathic pain. Inflammopharmacology. 2016;24(6):305–317.
    1. Mäntyselkä P, Kumpusalo E, Ahonen R, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain. 2001;89(2–3):175–180.
    1. Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4) Pain. 2005;114(1–2):29–36.
    1. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–1920.
    1. Mick G, Baron R, Correa-Illanes G, et al. 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):1357–1366.
    1. Pickering G, Pereira B, Clère F, et al. Cognitive function in older patients with postherpetic neuralgia. Pain Pract. 2014;14(1):E1–E7.
    1. 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;9:67–79.
    1. Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–e88.
    1. Gammaitoni AR, Alvarez NA, Galer BS. Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature. J Clin Pharmacol. 2003;43(2):111–117.
    1. Sheets MF, Hanck DA. Molecular action of lidocaine on the voltage sensors of sodium channels. J Gen Physiol. 2003;121(2):163–175.
    1. Sheets MF, Hanck DA. Outward stabilization of the S4 segments in domains III and IV enhances lidocaine block of sodium channels. J Physiol. 2007;582(pt 1):317–334.
    1. Meier T, Wasner G, Faust M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double-blind, placebo-controlled study. Pain. 2003;106(1–2):151–158.
    1. Meier T, Faust M, Hüppe M, Schmucker P. Reduktion chronischer Schmerzen bei nichtpostherpetischen peripheren Neuropathien nach topischer Behandlung mit Lidocainpflaster. [Reduction of chronic pain for non-postherpetic peripheral neuropathies after topical treatment with a lidocaine patch] Schmerz. 2004;18(3):172–178.
    1. Rehm S, Binder A, Baron R. Post-herpetic neuralgia: 5% lidocaine medicated plaster, pregabalin, or a combination of both? A randomized, open, clinical effectiveness study. Curr Med Res Opin. 2010;26(7):1607–1619.
    1. Lam VY, Wallace M, Schulteis G. Effects of lidocaine patch on intradermal capsaicin-induced pain: a double-blind, controlled trial. J Pain. 2011;12(3):323–330.
    1. Krumova EK, Zeller M, Westermann A, Maier C. Lidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers. Pain. 2012;153(2):273–280.
    1. Baron R, Binder A, Attal N, Casale R, Dickenson AH, Treede R-D. Neuropathic low back pain in clinical practice. Eur J Pain. 2016;20(6):861–873.
    1. emc [webpage on the Internet] Versatis 5% Medicated Plaster – Summary of Product Characteristics. 2017. [Accessed June 21, 2017]. Available from: .
    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(3):533–538.
    1. Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M. 5% lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy: an open-label, non-inferiority two-stage RCT study. Curr Med Res Opin. 2009;25(7):1663–1676.
    1. Navez ML, Monella C, Bösl I, Sommer D, Delorme C. 5% lidocaine medicated plaster for the treatment of postherpetic neuralgia: a review of the clinical safety and tolerability. Pain Ther. 2015;4(1):1–15.
    1. Wilhelm IR, Tzabazis A, Likar R, Sittl R, Griessinger N. Long-term treatment of neuropathic pain with a 5% lidocaine medicated plaster. Eur J Anaesthesiol. 2010;27(2):169–173.
    1. McCormack PL. Capsaicin dermal patch: in non-diabetic peripheral neuropathic pain. Drugs. 2010;70(14):1831–1842.
    1. Haanpää M, Treede R-D. Capsaicin for neuropathic pain: linking traditional medicine and molecular biology. Eur Neurol. 2012;68(5):264–275.
    1. Sawynok J. Topical and peripherally acting analgesics. Pharmacol Rev. 2003;55(1):1–20.
    1. Anand P, Bley K. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. Br J Anaesth. 2011;107(4):490–502.
    1. Derry S, Lloyd R, Moore RA, McQuay HJ. Topical capsaicin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2009;(4):CD007393.
    1. Babbar S, Marier J-F, Mouksassi M-S, et al. Pharmacokinetic analysis of capsaicin after topical administration of a high-concentration capsaicin patch to patients with peripheral neuropathic pain. Ther Drug Monit. 2009;31(4):502–510.
    1. Thomson, Micromedex . Drug Information for the Health Care Professional. Vol. 1. Greenwood Village, CO: Thomson/MICROMEDEX; 2006.
    1. Walpole CS, Wrigglesworth R, Bevan S, et al. Analogues of capsaicin with agonist activity as novel analgesic agents; structure-activity studies. 1. The aromatic “A-region”. J Med Chem. 1993;36(16):2362–2372.
    1. Reyes-Escogido Mde L, Gonzalez-Mondragon EG, Vazquez-Tzompantzi E. Chemical and pharmacological aspects of capsaicin. Molecules. 2011;16(2):1253–1270.
    1. Irving GA, Backonja M, Rauck R, Webster LR, Tobias JK, Vanhove GF. NGX-4010, a capsaicin 8% dermal patch, administered alone or in combination with systemic neuropathic pain medications, reduces pain in patients with postherpetic neuralgia. Clin J Pain. 2012;28(2):101–107.
    1. Ladjevic NG, Likic-Ladjevic IS. Topical glycopirrolate for the management of hyperhidrosis in herpetic neuralgia. Yonsei Med J. 2009;50(2):293–295.
    1. Haanpää ML, Gourlay GK, Kent JL, et al. Treatment considerations for patients with neuropathic pain and other medical comorbidities. Mayo Clin Proc. 2010;85(3 Suppl):S15–S25.
    1. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1:CD007393.
    1. Derry S, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2012;(9):CD010111.
    1. Lodge D. The history of the pharmacology and cloning of ionotropic glutamate receptors and the development of idiosyncratic nomenclature. Neuropharmacology. 2009;56(1):6–21.
    1. Ilkjaer S, Dirks J, Brennum J, Wernberg M, Dahl JB. Effect of systemic N-methyl-D-aspartate receptor antagonist (dextromethorphan) on primary and secondary hyperalgesia in humans. Br J Anaesth. 1997;79(5):600–605.
    1. Azevedo VM, Lauretti GR, Pereira NL, Reis MP. Transdermal ketamine as an adjuvant for postoperative analgesia after abdominal gynecological surgery using lidocaine epidural blockade. Anesth Analg. 2000;91(6):1479–1482.
    1. Sawynok J. Topical analgesics for neuropathic pain: preclinical exploration, clinical validation, future development. Eur J Pain. 2014;18(4):465–481.
    1. Anitescu M, Benzon HT, Argoff CE. Advances in topical analgesics. Curr Opin Anaesthesiol. 2013;26(5):555–561.
    1. Kopsky DJ, Keppel Hesselink JM, Bhaskar A, Hariton G, Romanenko V, Casale R. Analgesic effects of topical ketamine. Minerva Anestesiol. 2015;81(4):440–449.
    1. FDA [webpage on the Internet] Import Alert 66-41. 2016. [Accessed July 5, 2017]. [cited Nov 14, 2016]. Available from: .
    1. Bajaj S, Whiteman A, Brandner B. Transdermal drug delivery in pain management. Contin Educ Anaesth Crit Care Pain. 2011;11(2):39–43.
    1. Wallace M, Kudrow D, McElveen W, et al. Clinical trial results: a randomized, double-blind, placebo-controlled trial of a three-day bupivacaine patch (ELADUR™) in patients with post-herpetic neuralgia. Poster session presented at: The American Pain Society 27th Annual Meeting; Tampa, FL: 2008.
    1. Alessandri F, Lijoi D, Mistrangelo E, Nicoletti A, Crosa M, Ragni N. Topical diclofenac patch for postoperative wound pain in laparoscopic gynecologic surgery: a randomized study. J Minim Invasive Gynecol. 2006;13(3):195–200.
    1. Stanos SP, Galluzzi KE. Topical therapies in the management of chronic pain. Postgrad Med. 2013;125(4 Suppl 1):25–33.
    1. Jorge LL, Feres CC, Teles VE. Topical preparations for pain relief: efficacy and patient adherence. J Pain Res. 2010;4:11–24.
    1. Mazières B. Topical ketoprofen patch. Drugs R D. 2005;6(6):337–344.
    1. Ahmed SU, Zhang Y, Chen L, et al. Effect of 1.5% topical diclofenac on clinical neuropathic pain. Anesthesiology. 2015;123(1):191–198.
    1. Rascol O, Zesiewicz T, Chaudhuri KR, et al. A randomized controlled exploratory pilot study to evaluate the effect of rotigotine transdermal patch on Parkinson’s disease-associated chronic pain. J Clin Pharmacol. 2016;56(7):852–861.
    1. Gerner P, Kao G, Srinivasa V, Narang S, Wang GK. Topical amitriptyline in healthy volunteers. Reg Anesth Pain Med. 2003;28(4):289–293.
    1. Leclaire J, de Lacharriere O, Breton L, Societe L’Oreal SA Cosmetic/pharmaceutical compositions comprising β-adrenergic agonists/substance P antagonists. 5958432. US patent. 1999
    1. Juif PE, Melchior M, Poisbeau P. Characterization of the fast GABAergic inhibitory action of etifoxine during spinal nociceptive processing in male rats. Neuropharmacology. 2015;91:117–122.
    1. Allegri M, Baron R, Hans G, et al. A pharmacological treatment algorithm for localized neuropathic pain. Curr Med Res Opin. 2016;32(2):377–384.
    1. Derry S, Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2013;(2):CD007393.
    1. Barkin RL. The pharmacology of topical analgesics. Postgrad Med. 2013;125(4 Suppl 1):7–18.
    1. Pickering G. Antiepileptics for post-herpetic neuralgia in the elderly: current and future prospects. Drugs Aging. 2014;31(9):653–660.
    1. Pickering G, Lussier DA. Neuropathic pain. In: Lussier D, Cruciani R, editors. Pain Management in the Elderly Patient: A Comprehensive Guide to Diagnosis and Treatment. New York: Springer; 2017. In press 2017.
    1. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–351.
    1. Priano L, Gasco MR, Mauro A. Transdermal treatment options for neurological disorders: impact on the elderly. Drugs Aging. 2006;23(5):357–375.
    1. Casale R, Mattia C. Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: focus on 5% lidocaine-medicated plaster. Ther Clin Risk Manag. 2014;10:259–268.
    1. Seminowicz DA, Davis KD. A re-examination of pain-cognition interactions: implications for neuroimaging. Pain. 2007;130(1–2):8–13.
    1. Oluigbo CO, Salma A, Rezai AR. Targeting the affective and cognitive aspects of chronic neuropathic pain using basal forebrain neuromodulation: rationale, review and proposal. J Clin Neurosci. 2012;19(9):1216–1221.
    1. Wolfe GI, Barohn RJ. Painful peripheral neuropathy. Curr Treat Options Neurol. 2002;4(3):177–188.
    1. Pickering G. Impact of 5% lidocaine medicated plaster on allodynic symptoms of localized neuropathic pain after knee surgery. 2016. [Accessed July 5, 2017]. Available from: . NLM identifier: NCT02763592.
    1. Frost SG. Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report. Curr Ther Res Clin Exp. 2003;64(8):626–629.
    1. Nayak S, Cunliffe M. Lidocaine 5% patch for localized chronic neuropathic pain in adolescents: report of five cases. Paediatr Anaesth. 2008;18(6):554–558.
    1. Rasolofo J, Poncelet M, Rousseau V, Marec-Berard P. Efficacité des emplâtres de lidocaïne 5 % sur les douleurs des crises vaso-occlusives chez l’enfant drépanocytaire. [Analgesic efficacy of topical lidocaine for vaso-occlusive crisis in children with sickle cell disease] Arch Pediatr. 2013;20(7):762–767.
    1. Friedrichsdorf SJ, Nugent AP. Management of neuropathic pain in children with cancer. Curr Opin Support Palliat Care. 2013;7(2):131–138.
    1. Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci. 2005;6(7):507–520.
    1. Sarbacker GB. Topical therapies for chronic pain management: a review of diclofenac and lidocaine. US Pharm. 2015;40(3):35–38.
    1. Groninger H, Schisler RE. Topical capsaicin for neuropathic pain #255. J Palliat Med. 2012;15(8):946–947.
    1. Üçeyler N, Sommer C. High-dose capsaicin for the treatment of neuropathic pain: what we know and what we need to know. Pain Ther. 2014;3(2):73–84.
    1. Simpson DM, Robinson-Papp J, Van J, et al. Capsaicin 8% patch in painful diabetic peripheral neuropathy: a randomized, double-blind, placebo-controlled study. J Pain. 2017;18(1):42–53.
    1. Mogil JS. Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon. Nat Rev Neurosci. 2012;13(12):859–866.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅