[Topical pharmacologic approach with 5% lidocaine medicated plaster in the treatment of localized neuropathic pain]. / Approccio farmacologico topico con lidocaina cerotto 5% nel trattamento del dolore neuropatico localizzato.

The treatment of neuropathic pain is a medical challenge. The responsiveness to the different classes of drugs is often unsatisfactory and frequently associated to a wide range of side effects. International guidelines suggest for the "localized" neuropathic pain the topical treatment with 5% lidocaine medicated plaster, alone or associated to systemic drugs, as the first choice since its favorable efficacy and tolerability profile. Many clinical experiences support the rationale for using 5% lidocaine medicated plaster in different kinds of localized neuropathic pain, such as postherpetic and trigeminal neuralgia, compressive syndromes, painful diabetic polyneuropathy and pain secondary to trauma or surgical interventions. This paper reports a series of clinical cases whose heterogeneity suggests the wide burden of applicability of the topical 5% lidocaine, either alone and associated to systemic drugs. All the described conditions were characterized by a highly intense pain, not adequately controlled by actual medications, which improved after the use of topical lidocaine. The good response to lidocaine allowed the reduction, of even the withdrawal, of concurrent drugs and improved the patients' quality of life.

[Experience with 5% lidocaine medicated plaster in the treatment of localized neuropathic pain]. / Esperienza con lidocaina cerotto 5% nel trattamento del dolore neuropatico localizzato.

AIM: The aim of this paper is to confirm the efficacy and safety in clinical practice of 5% lidocaine medicated plaster (LMP) in the treatment of localized neuropathic pain. METHODS: Retrospective, observational study carried out in the period 2006-2012, in patients with various forms of localized peripheral neuropathic pain treated with LMP. Only patients with at least one follow-up visit after prescription of the drug were assessed. RESULTS: One hundred and one patients were assessable, 60.4% of whom suffered from postherpetic neuralgia (PHN), while the remainder reported mainly post-traumatic/post-surgical neuropathic pain and other superficial localized neuralgias. In baseline conditions, the mean pain intensity measured on the NRS was 6.1. The median treatment time with LMP was 41 days, at the end of which there was a 64% fall in NRS, with no significant differences between the patients with PHN or other localized neuralgias. A better NRS reduction trend was also observed in those patients who, in our study, started treatment with LMP from the first visit, compared with those patients to whom LMP was prescribed later. The tolerability was good, with few adverse events at the application site, which led to suspension of treatment in just three cases. CONCLUSION: In our experience, LMP proved to be an effective and well-tolerated drug in the treatment of PHN and other superficial localized neuralgias. This observation is in agreement with the international guidelines, which suggest LMP as first line treatment for the management of localized peripheral neuropathic pain.

Treatment of postoperative pain with suprofen injected by the intramuscular route.

The analgesic effect and the tolerability of alpha-methyl-4-(2-thienyl-carbonyl)phenylacetic acid (suprofen, Suprol) 200 mg/ml were compared with lysine acetylsalicylate 0.9 g/2.5 ml; the study included 60 subjects in severe to very severe pain following orthopedic surgery. The trial was performed in randomized single-blind fashion in patients who had given informed consent. The substances were injected into the upper out quadrant; maximally 4 intramuscular injections were given within 2 days. The test population was homogeneous with respect to the anamnestic data. The intensity of pain prior to treatment was comparable in both groups. Statistical analysis of the data revealed that suprofen was at the rating times (15 min to 4 h) significantly superior to the control groups. The investigator's and the patients' final appreciation indicated good to very good effect in 93% of the subjects on suprofen, and in 40 and 47%, respectively, of the patients in the control group. Here, too, suprofen was significantly superior to the reference Substance. Systemic and local tolerability of both drugs was very good. Adverse drug experience (heartburn) occurred in only 1 patient in the control group.