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Another possible treatment for neuropathic pain....

Posted by Ed Davis, DPM on 7/30/03 at 00:48 (125621)

Lidocaine Patch Provides Effective Analgesia for Painful Diabetic Neuropathy
posted 12/18/02

A transdermal patch, Lidoderm (lidocaine 5 percent) appears to provide significant improvement in both pain intensity and pain relief for patients with painful diabetic neuropathy.

That, from the researchers at the clinical meeting of the American Society of Health-System Pharmacists on December 10th

The results are important, researchers said, because the condition affects more than 50 percent of elderly patients with diabetes and is notoriously difficult to treat effectively.

The lidocaine patch is a targeted peripheral analgesic that has proved effective in treating postherpetic neuralgia. As such, it may be a potentially powerful strategy for treating painful diabetic neuropathy, according to the researchers, led by Stephanie Hart-Gouleau, MD, of the department of anaesthesiology at the University of Rochester School of Medicine, in Rochester, New York, United States.

The multi-centre, three-week, open-label, prospective trial included 56 men and four women aged 18 to 90 years with painful diabetic neuropathy of at least three months' duration and average daily pain ratings of 4 or higher on numeric pain scale.

Patients were treated with up to four lidocaine patches daily applied to areas of maximal peripheral neuropathic pain, in an 18-hours-on, six-hours-off manner. They were permitted to continue their analgesic medication regimen throughout the trial, as long as dosing remained stable.

For the 51 patients who completed the three weeks of treatment, the lidocaine patch provided significant reductions in pain. At baseline, mean overall pain relief from current therapy was 28.8 percent, compared to a mean of 63.1 percent at the end of the three weeks.

The results are encouraging, the researchers said, because the patch provided analgesia without local anaesthesia, and there were no serious treatment-related systemic adverse events or drug-to-drug interactions. The most frequently reported adverse event, which affected seven patients, was application site burning.

The researchers said that in light of the promising nature of the results, additional controlled clinical trials should be undertaken to further characterise the efficacy of the lidocaine patch in treating painful diabetic neuropathy.

Source: Diabetes In Control Dot Com.

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Re: Another possible treatment for neuropathic pain....

Sharon W on 7/30/03 at 08:21 (125626)

Thanks, Dr. Ed, for sharing that. I think I may show it to my Dr.

Sharon
:)

Re: Another possible treatment for neuropathic pain....

Terry Z on 7/30/03 at 09:35 (125634)

Dr. Ed,
I've been using these patches for over a year and they do help. The only problem so far is sometimes I put them on the bottom of my feet and the gel or whatever sticks in areas that are walked on. But it's worth it I'll do anything to help the RSD pain, Neuromas and whatevers wrong with my left foot.
Terry

Re: Sharon

Terry Z on 7/30/03 at 10:00 (125642)

Sharon,
I read that you are changing Neurontin to Topamax these patches may help you through this painful period. I'm very interested to see how you compare these two drugs I couldn't function on 2400mg. of Neurontin so I went back down to 1800. Topamaz was mentioned to me but Neurontin seems to help most of the time and I'm frankly scared to change. I tried Zonagran but got terrible ringing in ears. Good luck with Topamax I hope you give the patches a try, your doctor should be able to give you a few samples.
Terry

Re: For Terry

Sharon W on 7/30/03 at 10:54 (125660)

Terry,

Great minds think alike!! ;)

I don't know about samples but I do think the lidocaine patches might be a good idea, to help me get thorough this painful transition. It isn't fun and games, dropping back on Neurontin (but I'm sure you know that, since you dropped back from 2400 to 1800).

I'm also wondering if it would be a good idea to continue taking BOTH drugs, say Neurontin 600mg in the morning and then Topamax in the afternoon and evening. But, I don't know how the two drugs interact, or whether their interaction causes worse side effects than larger doses of one drug or the other. I will ask my doctor, but I'm afraid this might be one of those questions that noone knows the answer to...

Sharon
:)

Re: For Sharon

Terry Z on 7/30/03 at 11:47 (125668)

Sharon,
Taking both drugs! Somehow I don't think that's a good idea but you never know. I'm trying to find a RSD specialist in the area and that's been a kick I sometimes think we as patience help each other more.
Terry

Re: For Sharon

Sharon W on 7/30/03 at 13:04 (125683)

Terry,

Sometimes I think we as patients help each others more than the doctors do, too. I think it's because we care about each other, because we understand what it's like, because we encounter similar frustrations and endure similar pain and cling to similar hopes... And because we know, FAR MORE THAN DOCTORS DO, what it means to be faced with an apathetic shrug and told that we will have to 'live with it'.

I'll tell you one thing for sure, it's a good idea to know as much as you can about your own health problems and how they are being treated -- not just what your own doctor has recommended (although I ALWAYS check out any drug or treatment or medical test prescribed for a member of my family) but what OTHER treatments are available and in use for your condition... Some doctors do resent it, if you go in with ideas of your own about a change that you would like to make, but there are other doctors who understand that it is your body and who will work WITH you to find appropriate solutions.

OF COURSE, it is the doctor who makes the decision in the end. But I do think the patient should be part of the decision-making process.

Sharon
:)

Re: Another possible treatment for neuropathic pain....

BrianG on 7/30/03 at 22:50 (125744)

I had read about these Lidocaine patches quite awhile ago. Since I do not have neuropathy, I decided to try the Lidocaine on my heels for PF. My doctor gave me a script for 5% Ldocaine gel. which I rubbed on to my heels 2-3 times a day. Nothing. I also followed up the Lidocaine gel with DMSO, to help bring the Lidocaine deeper into my body. Still nothing. It seems it may work for nerve type pain, but not so much for inflamation problems (PF).

Good luck
BrianG

PS The Lidocaine gel works great for tooth, and gum, problems!

Re: Another possible treatment for neuropathic pain....

Ed Davis, DPM on 7/30/03 at 23:25 (125747)

Brian:

The patches are FDA approved only for post herpetic neuralgia so far. A very small amount of lidocaine gets through intact skin, not enough to cause numbness but enough to provide some pain relief. The depth of penetration is small so the source of pain must be close to the surface of the skin. That can be the case with some PN.

Another way to enhance penetration of lidocaine is via iontophoresis. Still not a lot of depth but better than topical application. Ionto seems to work in musculoskelatal conditions when the target is close to the surface eg. the achilles tendon.
Ed

Re: Another possible treatment for neuropathic pain....

Ed Davis, DPM on 7/30/03 at 23:27 (125748)

In diabetic neuropathy, small pain fibers/receptors close to the skin surface are involved and that may be a reason for the positive response to the lidocaine patch.
Ed

Re: Dr. Ed: Lidocaine patches for small-fiber neuropathy?

Sharon W on 7/31/03 at 08:00 (125765)

Dr. Ed,

Do you think the patches probably only help with small fiber then (or that they are most helpful if the pain is due to small fiber neuropathy)?

Sharon
:-/

Re: Dr. Ed: Lidocaine patches for small-fiber neuropathy?

Ed Davis, DPM on 8/01/03 at 20:25 (125950)

Sharon:
I believe that the effectiveness may be more related to the proximity of the nerve fibers to the skin surface since the depth of penetration is limited. Since diabetic neuropathy often involves the small fibers close to the skin surface, the patches may be effective.
Ed

Re: Another possible treatment for neuropathic pain....

Tammie on 8/02/03 at 13:35 (126011)

Hmmmmmmm I am going to talk with my PM Dr. about this also. As I did get my Spinal implant I still did NOT get any foot coverage at all! He said that is not surprising as when the RSD spreads you have to try to get the best coverage and hope to get most. But being a large area I did not get my foot. I do have a lot of copy cat stuff on other side right now ,but the trouble remains my bad foot the one with the two surgeries. The pain meds and such have never reached it enough to calm it and I am still walking on my toes do to heel pain.

I wonder if some kinda patch type med on my bad foot could help? I have wondered about seeing a POD again?? But am so very fearful at this point. I am not. The future could mean a new lead change to cover this area? Or possible another spinal implant to cover more. I am a bit unsure if I need this all right now. Any ideas anyone?