Skip to main content
SpringerLink
Log in

Review of Lidocaine Patch 5% Studies in the Treatment of Postherpetic Neuralgia

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Postherpetic neuralgia (PHN) is a chronic pain syndrome that disproportionately affects the elderly; its incidence is anticipated to increase as the population ages. PHN presents as pain (continuous burning or intense paroxysmal), most often with tactile allodynia, which may be severe and disabling, resulting in poor quality of life and depression. Traditional treatments have included tricyclic antidepressants, anticonvulsants and opioids; however, adverse systemic effects associated with these agents have led to the development of a newer and potentially safer agent, the topical lidocaine patch 5% (Lidoderm®), a targeted peripheral analgesic.

This article reviews the clinical pharmacology of the lidocaine patch 5% for the treatment of PHN and summarises data from clinical trials of its safety, tolerability and efficacy. The Medline search terms ‘lidocaine’ and ‘patch’ were used to search for English-language articles on the pharmacokinetics of the lidocaine patch 5% and its clinical use for the treatment of PHN. Additional published studies not identified by the database search but performed by the authors or their colleagues were also included in the review.

The systemic absorption of lidocaine from the patch was minimal in healthy adults when four patches were applied for up to 24 hours/day, and lidocaine absorption was even lower among PHN patients than healthy adults at the currently recommended dose. Vehicle-controlled and open-label trials found the lidocaine patch 5%, either alone or in combination with other agents, to be effective in the treatment of PHN. Most adverse events were at patch application sites; no clinically significant systemic adverse effects were noted, including when used long term or in an elderly population.

In patients with PHN, the lidocaine patch 5% has demonstrated relief of pain and tactile allodynia with a minimal risk of systemic adverse effects or drug-drug interactions. Because of its proven efficacy and safety profile, the lidocaine patch 5% has been recommended as a first-line therapy for the treatment of the neuropathic pain of PHN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1

Similar content being viewed by others

Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Watson CP. A new treatment for postherpetic neuralgia. N Engl J Med 2000 Nov 23; 343(21): 1563–5

    Article  PubMed  CAS  Google Scholar 

  2. Donahue JG, Choo PW, Manson JE, et al. The incidence of herpes zoster. Arch Intern Med 1995 Aug 7–21; 155(15): 1605–9

    Article  PubMed  CAS  Google Scholar 

  3. Gnann Jr JW, Whitley RJ. Clinical practice: herpes zoster. N Engl J Med 2002 Aug 1; 347(5): 340–6

    Article  PubMed  Google Scholar 

  4. Lee PJ, Annunziato P. Current management of herpes zoster. Infect Med 1998; 15: 709–13

    Google Scholar 

  5. Choo PW, Galil K, Donahue JG, et al. Risk factors for postherpetic neuralgia. Arch Intern Med 1997 Jun 9; 157(11): 1217–24

    Article  PubMed  CAS  Google Scholar 

  6. Kost RG, Straus SE. Postherpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med 1996 Jul 4; 335(1): 32–42

    Article  PubMed  CAS  Google Scholar 

  7. Schmader K. Postherpetic neuralgia in immunocompetent elderly people. Vaccine 1998 Nov; 16(18): 1768–70

    Article  PubMed  CAS  Google Scholar 

  8. Dworkin RH, Schmader KE. Treatment and prevention of postherpetic neuralgia. Clin Infect Dis 2003 Apr 1; 36(7): 877–82

    Article  PubMed  Google Scholar 

  9. Rowbotham MC, Fields HL. Post-herpetic neuralgia: the relation of pain complaint, sensory disturbance, and skin temperature. Pain 1989 Nov; 39(2): 129–44

    Article  PubMed  CAS  Google Scholar 

  10. Nurmikko T, Wells C, Bowsher D. Sensory dysfunction in postherpetic neuralgia. In: Boivie J, Hansson P, Lindblom U, editors. Touch, temperature and pain in health and disease: mechanisms and assessments. Seattle (WA): IASP Press, 1994: 133–41

    Google Scholar 

  11. Watson CP, Evans RJ, Reed K, et al. Amitriptyline versus placebo in postherpetic neuralgia. Neurology 1982 Jun; 32(6): 671–3

    Article  PubMed  CAS  Google Scholar 

  12. Kishore-Kumar R, Max MB, Schafer SC, et al. Desipramine relieves postherpetic neuralgia. Clin Pharmacol Ther 1990 Mar; 47(3): 305–12

    Article  PubMed  CAS  Google Scholar 

  13. Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998 Dec; 280(21): 1837–42

    Article  PubMed  CAS  Google Scholar 

  14. Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998 Jun; 50(6): 1837–41

    Article  PubMed  CAS  Google Scholar 

  15. Rowbotham MC, Twilling L, Davies PS, et al. Oral opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med 2003 Mar 27; 348(13): 1223–32

    Article  PubMed  CAS  Google Scholar 

  16. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis. I: psychotropic drugs. J Am Geriatr Soc 1999 Jan; 47(1): 30–9

    CAS  Google Scholar 

  17. Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 1989 Aug; 21 (2 Pt 1): 265–70

    Article  PubMed  CAS  Google Scholar 

  18. Watson CP, Tyler KL, Bickers DR, et al. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993 May–Jun; 15(3): 510–26

    PubMed  CAS  Google Scholar 

  19. Litman SJ, Vitkun SA, Poppers PJ. Use of EMLA cream in the treatment of post-herpetic neuralgia. J Clin Anesth 1996 Feb; 8(1): 54–7

    Article  PubMed  CAS  Google Scholar 

  20. Collins PD. EMLA cream and herpetic neuralgia. Med J Aust 1991 Aug 5; 155(3): 206–7

    PubMed  CAS  Google Scholar 

  21. Wheeler JG. EMLA cream and herpetic neuralgia [letter]. Med J Aust 1991 Jun 3; 154(11): 781

    PubMed  CAS  Google Scholar 

  22. Stow PJ, Glynn CJ, Minor B. EMLA cream in the treatment of post-herpetic neuralgia: efficacy and pharmacokinetic profile. Pain 1989 Dec; 39(3): 301–5

    Article  PubMed  CAS  Google Scholar 

  23. Attal N, Brasseur L, Chauvin M, et al. Effects of single and repeated applications of a eutectic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in postherpetic neuralgia. Pain 1999 May; 81(1–2): 203–9

    Article  PubMed  CAS  Google Scholar 

  24. Chabal C, Russell LC, Burchiel KJ. The effect of intravenous lidocaine, tocainide, and mexiletine on spontaneously active fibers originating in rat sciatic neuromas. Pain 1989 Sep; 38(3): 333–8

    Article  PubMed  CAS  Google Scholar 

  25. Devor M, Govrin-Lippmann R, Angelides K. Na+ channel immunolocalization in peripheral mammalian axons and changes following nerve injury and neuroma formation. J Neurosci 1993 May; 13(5): 1976–92

    PubMed  CAS  Google Scholar 

  26. Baron R. Peripheral neuropathic pain: from mechanisms to symptoms. Clin J Pain 2000 Jun; 16 (2 Suppl.): S12–20

    Article  PubMed  CAS  Google Scholar 

  27. Kennedy PG. Varicella-zoster virus latency in human ganglia. Rev Med Virol 2002 Sep–Oct; 12(5): 327–34

    Article  PubMed  CAS  Google Scholar 

  28. Rowbotham MC, Davies PS, Fields HL. Topical lidocaine gel relieves postherpetic neuralgia. Ann Neurol 1995 Feb; 37(2): 246–53

    Article  PubMed  CAS  Google Scholar 

  29. Lidoderm® (lidocaine patch 5%) prescribing information. Chadds Ford (PA): Endo Pharmaceuticals Inc., 2000

  30. Comer AM, Lamb HM. Lidocaine patch 5%. Drugs 2000 Feb; 59(2): 245–9

    Article  PubMed  CAS  Google Scholar 

  31. Campbell BJ, Rowbotham M, Davies PS, et al. Systemic absorption of topical lidocaine in normal volunteers, patients with post-herpetic neuralgia, and patients with acute herpes zoster. J Pharm Sci 2002 May; 91(5): 1343–50

    Article  PubMed  CAS  Google Scholar 

  32. Galer BS. Lidocaine patch 5%: viewpoints. Drugs 2000 Feb; 59(2): 250–1

    Article  Google Scholar 

  33. Galer BS. Effectiveness and safety of lidocaine patch 5%. J Fam Pract 2002 Oct; 51(10): 867–8

    PubMed  Google Scholar 

  34. Argoff CE. Lidocaine patch 5% and the management of chronic pain [letter]. South Med J 2002 Jul; 95(7): 781

    Article  PubMed  Google Scholar 

  35. Gammaitoni AR, Davis MW. Pharmacokinetics and tolerability of lidocaine patch 5% with extended dosing. Ann Pharmacother 2002 Feb; 36(2): 236–40

    Article  PubMed  CAS  Google Scholar 

  36. Gammaitoni AR, Alvarez NA, Galer BS. Pharmacokinetics and safety of continuously applied lidocaine patches 5%. Am J Health Syst Pharm 2002 Nov 15; 59(22): 2215–20

    PubMed  CAS  Google Scholar 

  37. Rowbotham MC, Davies PS, Verkempinck C, et al. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain 1996 Apr; 65(1): 39–44

    Article  PubMed  CAS  Google Scholar 

  38. Galer BS, Rowbotham MC, Perander J, et al. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 1999 Apr; 80(3): 533–8

    Article  PubMed  CAS  Google Scholar 

  39. Galer BS, Jensen MP, Ma T, et al. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the neuropathic pain scale. Clin J Pain 2002 Sep—Oct; 18(5): 297–301

    Article  PubMed  Google Scholar 

  40. Rowbotham MC, Davies PS, Galer BS. Multicenter, double-blind, vehicle-controlled trial of long-term use of lidocaine patches for postherpetic neuralgia [abstract no. 184]. In: Abstracts of the 8th World Congress of the International Association for the Study of Pain; 1996 Aug 17–22; Vancouver (BC). Proceedings of the 8th World Congress on Pain. San Diego (CA): IASP Press, 1997: 274

    Google Scholar 

  41. Katz NP, Gammaitoni AR, Davis MW, et al. Lidocaine patch 5% reduces pain intensity and interference with quality of life in patients with postherpetic neuralgia: an effectiveness trial: the Lidoderm Patch Study Group. Pain Med 2002; 3(4): 324–32

    Article  PubMed  Google Scholar 

  42. Galer BS, Gammaitoni AR. More than 7 years of consistent neuropathic pain relief in geriatric patients. Arch Intern Med 2003 Mar 10; 163(5): 628

    Article  PubMed  Google Scholar 

  43. Benowitz NL, Meister W. Clinical pharmacokinetics of lignocaine. Clin Pharmacokinet 1978 May–Jun; 3(3): 177–201

    Article  PubMed  CAS  Google Scholar 

  44. Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology 1997 Feb; 48(2): 332–8

    Article  PubMed  CAS  Google Scholar 

  45. McAlister FA, Straus SE, Guyatt GH, et al. Users’ guides to the medical literature. Integrating research evidence with the care of the individual patient: Evidence-Based Medicine Working Group. JAMA 2000 Jun 7; 283(21): 2829–36

    CAS  Google Scholar 

  46. 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: 151–8

    Article  PubMed  CAS  Google Scholar 

  47. Raja SN, Haythornthwaite JA, Pappagallo M, et al. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2002 Oct; 59(7): 1015–21

    Article  PubMed  CAS  Google Scholar 

  48. Rice AS, Maton S. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001 Nov; 94(2): 215–24

    Article  PubMed  CAS  Google Scholar 

  49. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain 1999 Dec; 83(3): 389–400

    Article  PubMed  CAS  Google Scholar 

  50. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003; 60(11): 1524–34

    Article  PubMed  Google Scholar 

  51. Gimbel J, Hale M, Linn R, et al. Lidocaine patch 5% in patients with acute/subacute and chronic low back pain: impact on pain intensity, pain relief, and pain interference with quality of life [abstract no. 878]. J Pain 2003; 4 Suppl. 1: 71

    Google Scholar 

  52. Gammaitoni AR, Galer BS, Burch F, et al. Effectiveness and safety of the lidocaine patch 5% as monotherapy in patients with pain from osteoarthritis of the knee [abstract no. 906]. J Pain 2003; 4 Suppl. 1: 78

    Google Scholar 

Download references

Acknowledgements

All lidocaine patch 5% studies reviewed (except Meier et al.[46]) were supported by a grant from Hind Health Care, Inc. or Endo Pharmaceuticals Inc. Bradley S. Galer, MD, is an employee of Endo Pharmaceuticals, Inc., the US marketer of the lidocaine patch 5%, and has a royalty agreement with Hind Health Care, Inc.

Author information

Authors and Affiliations

  1. Department of Neurology, Seattle Veteran’s Medical Center, Seattle, Washington, USA

    Pamela S. Davies

  2. Endo Pharmaceuticals Inc., Chadds Ford, 100 Painters Drive, Pennsylvania, 19317, USA

    Bradley S. Galer

  3. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    Bradley S. Galer

Authors
  1. Pamela S. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bradley S. Galer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradley S. Galer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Davies, P.S., Galer, B.S. Review of Lidocaine Patch 5% Studies in the Treatment of Postherpetic Neuralgia. Drugs 64, 937–947 (2004). https://doi.org/10.2165/00003495-200464090-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200464090-00002

Keywords

Search

Navigation