Treatment with the lidocaine patch and no other pharmacologic intervention continues to provide good results in this patient and has not been associated with any adverse events. The patient's LBP has remained resolved and direct application of the lidocaine patch has provided effective pain relief of his foot. A year-old woman with a year history of back pain presented in October with low right back pain aching and burning that extended to her buttocks and right leg.
The patient also reported muscle spasms in her back, but denied hyperalgia or allodynia. Magnetic resonance imaging in had indicated a herniated disc L4—L5 and idiopathic and degenerative scoliosis.
At the time of presentation, the patient was being treated with citalopram 60 mg qd , olanzapine 5 mg qd , lorazepam 1 mg qd or bid , and cyclobenzaprine 10 mg prn. She was also receiving hormone replacement therapy. The patient had failed prior treatment with hydrocodone due to constipation , fluoxetine lack of efficacy , amitriptyline sedation , venlafaxine lack of efficacy , and buspirone lack of efficacy. In December , therapy was changed with the substitution of clonidine 3 mg qd for lorazepam, the addition of baclofen 20 mg tid , and another trial of venlafaxine mg qd.
Gabapentin mg tid was also added. Initially, the patient noted some short-term pain relief with the patch. Further evaluation in March indicated that her burning pain responded well to the combination of the lidocaine patch and gabapentin.
At present, she continues this therapeutic regimen with good efficacy and no adverse events. Chronic LBP is a complex and difficult-to-treat condition that may often involve multiple pain mechanisms, including neuropathic, myofascial, and chronic inflammatory elements [4,5,9,14].
It is currently believed that NSAIDs, cyclo-oxygenase-2 inhibitors, and opioids may be beneficial if nociceptive pain is present in patients with this condition. Muscle relaxants are actually sedative—hypnotic drugs that do not have direct activity on the muscle and are thought by many pain authorities not to possess analgesic properties [15,16]. If a neuropathic component is believed to be present in a patient with LBP, then those drugs often prescribed for the treatment of neuropathic pain, e.
Tricyclic antidepressants may have mechanisms related to the endogenous central nervous pain-modulating system or may have sodium-channel-blocking activity. Some anticonvulsants also possess a sodium-channel-antagonistic mechanism, whereas others, such as gabapentin, have unknown analgesic mechanisms [17]. It is frequently found that patients with chronic LBP have little response to, or great difficulty in tolerating, treatment with these analgesics [18,19].
Results from controlled clinical trials have demonstrated that the lidocaine patch is effective for the treatment of neuropathic pain associated with PHN [10—12]. Recent clinical experience indicates that the lidocaine patch may also be effective for the treatment of other neuropathic and non-neuropathic pain states [10,13,20]. Most recently, Dalpiaz et al. In the treatment of neuropathic pain, e. In myofascial pain, however, the mechanism of action is less clear.
It can be hypothesized that a similar mechanism of action is occurring, i. In patient 3, a multimodal treatment regimen, including the lidocaine patch, was shown to help reduce swelling. A recent study demonstrated the immunoregulatory effects of lidocaine on T cells in patients with allergic asthma [21]. The lidocaine patch may, therefore, also possess anti-inflammatory actions. In patient 4, the combination of the lidocaine patch and gabapentin was successful in managing burning pain and allodynia of the lower back.
In regard to allodynia, there are four theoretical mechanisms to explain the possible beneficial effects of the lidocaine patch in this patient. First, blockade of abnormally functioning sodium channels on damaged peripheral nerves may decrease ectopic nociceptive pain signals transmitted to the dorsal horn of the spinal cord.
Second, the lidocaine patch may act as a mechanical barrier to the area of allodynia, thus preventing stimulation [10].
The fourth possibility is interruption of the proposed mechanism of antidromic neurogenic inflammation. Efferent stimulation of injured nerves via antidromic signals traveling back down afferent nociceptors is speculated to cause inflammation that does not respond to NSAIDs or cyclo-oxygenase-2 inhibitors.
Release of histamines, substance P, and calcitonin-gene-related peptide causes recruitment of non-nociceptors. It is possible that the lidocaine patch interrupts this cycle [22—24]. In comparison with other drugs currently being prescribed to treat LBP, the lidocaine patch has several important clinical advantages in the management of pain syndromes.
Thus, there are no significant pharmacokinetic or pharmacologic interactions with other drugs [25]. Although three of the patients had the lidocaine patch added as part of a multimodal intervention, patient 2 had the patch added as the sole intervention. The use of a combination of interventions is reflective of general clinical practice and, therefore, we recognize that the successful pain relief observed in patients 1, 3, and 4 cannot be solely attributed to the lidocaine patch. Further controlled trials are needed to fully examine the effect of the lidocaine patch in LBP.
One such trial, in which the authors are participating investigators, is ongoing [26]. Prospective, controlled trials should be conducted to further evaluate the utility of the lidocaine patch for the treatment of this condition. We would also like to express thanks to Adelphi Inc.
The labor productivity effects of chronic backache in the United States. Med Care ; 36 : — Google Scholar. Low back pain: risk factors for chronicity.
Rev Rheum Engl Ed ; 64 : — Efficacy of transverse tripolar stimulation for relief of chronic low back pain: Results of a single center. Stereotact Funct Neurosurg ; 73 : — Using gabapentin to treat failed back surgery syndrome caused by epidural fibrosis: A report of 2 cases. Arch Phys Med Rehabil ; 82 : — 3. Deyo RA. Drug therapy for back pain. Which drugs help which patients? Spine ; 21 : — Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.
Curr Opin Rheumatol ; 11 : — 7. Spinal drug delivery. Curr Pain Headache Rep ; 5 : — 6. Gill K Blumenthal SL. Functional results after anterior lumbar fusion at L5—S1 in patients with normal and abnormal MRI scans. Spine ; 17 : — 2. Pongratz D Spath M. Guideline for symptomatic therapy. Argoff CE. New analgesics for neuropathic pain: The lidocaine patch.
Clin J Pain ; 16 : S62 — 6. Lidocaine patch: Double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain ; 65 : 39 — Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: Results of an enriched enrollment study.
Pain ; 80 : — 8. Initial efficacy trial of topical lidocaine patches in the management of chronic myofascial pain. Can a pharmacological pain analysis in patients with chronic low back pain predict the outcome of lumbar fusion?
Preliminary report. Eur Spine J ; 5 : — Evaluation and management of back pain: preventing disability. J Back Muskuloskeletal ; 9 : — Attal N. Pharmacologic treatment of neuropathic pain. Acta Neurol Belg ; : 53 — Chronic neuropathic pain: Mechanisms and treatment.
Clin J Pain ; 16 : S — Watson CPN. The treatment of neuropathic pain: Antidepressants and opioids. Clin J Pain ; 16 : S49 — Devers A Galer BS. Topical lidocaine patch relieves a variety of neuropathic pain conditions: An open-label study. Clin J Pain ; 16 : — 8.
Inhibitory effect of lidocaine on T cells from patients with allergic asthma. J Allergy Clin Immunol ; : — Prescription patches and topical systems may be cut into smaller sizes with scissors prior to removal of the release liner.
Be sure to remove the current patch before you apply a new one. Do not let lidocaine transdermal come in contact with your eyes. If lidocaine transdermal does touch your eye, immediately wash the eye with water or saline and protect the eye until sensation returns. While you are wearing a lidocaine transdermal patch or system, protect the treated area from direct heat such as heating pads or electric blankets.
You can apply the lidocaine 1. Do not bandage the affected area tightly. If you are using the prescription lidocaine 1. If the lidocaine 1. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. This medication is usually used as needed. If your doctor has told you to use lidocaine patches or topical systems regularly, apply the missed patch or topical system as soon as you remember it.
However, if it is almost time for the next dose, skip the missed patch and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one.
Lidocaine transdermal may cause other side effects. Call your doctor if you have any unusual problems while using this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom. Do not store patches and topical systems outside the sealed envelope. Fold used patches or topical systems so that the adhesive side sticks to itself and then safely discard into trash and where children and pets cannot get to them.
It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. If you wear too many lidocaine transdermal patches or topical systems or wear them for too long, too much lidocaine may be absorbed into your blood.
In that case, you may experience symptoms of an overdose. In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Do not let anyone else use your medication.
Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital.
It is also important information to carry with you in case of emergencies. Lidocaine Transdermal Patch pronounced as lye' doe kane. Why is this medication prescribed? How should this medicine be used?
Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow?
0コメント