Real-world data confirmed that topical delivery of lidocaine via medicated plaster effectively treated localized peripheral neuropathic pain unsuccessfully treated with first-line oral medications in the outpatient setting. These findings were published in Pain Management.

This noninterventional retrospective cohort study evaluated patient records from the German Pain eRegistry. Patients with localized peripheral neuropathic pain who had one or more previous first-line oral medications who newly initiated treatment with 700 mg lidocaine medicated plaster (LMP; n=3081) or other oral medications  (n=3081) before December 2018 were propensity-matched and evaluated for pain outcomes using the 100-mm visual analog scale (VAS) up to July 2019.

The LMP and oral medication cohorts were aged mean 60.7±14.5 and 60.8±14.6 years, 64% and 64% were women, 49.2% and 49.2% had Mainz Pain Staging System chronicity stage 3, 57.5% and 57.5% had von Korff chronic pain grade 4, and the average number of comorbidities per patient was 3.7±2.1 and 3.7±2.0, respectively.


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Among the localized peripheral neuropathic pain cohort, 1711 had postherpetic neuralgia (PHN) and 1370 had diabetic polyneuropathy, postsurgical neuropathy, or other localized peripheral neuropathic pain conditions.

The LMP and oral medication groups were taking antidepressants (87.7% vs 88.4%), antiepileptics (68.5% vs 67.5%), strong opioid analgesics (65.7% vs 66.4%), rescue medication (52.5% vs 53.9%), nonopioid analgesics (25.6% vs 25.4%), and mild opioid analgesics (18.7% vs 19.5%), respectively.

The absolute mean change (AMC) in 24-hour pain intensity was more greatly reduced among the LMP recipients at 4 (AMC, -29.2 vs -19.1; P <.001), 12 (AMC, -31.0 vs -17.1; P <.001), and 24 (AMC, -31.4 vs -16.9; P <.001) weeks.

VAS 24-hour pain intensity scores averaged over 4, 12, and 24 weeks after treatment initiation was more greatly reduced by LMP among all patients (least squares mean difference [LSMD], -13.06; P <.001), patients with PHN (LSMD, -13.03; P <.001), and other localized peripheral neuropathic pain syndromes (LSMD, -13.1; P <.001).

LMP was associated with greater treatment persistence (relative risk [RR], 1.61; 95% CI, 1.55-1.68; P <.001). Among patients who discontinued, more LMP recipients no longer required treatment (RR, 2.39; 95% CI, 2.04-2.80; P <.001) and fewer discontinued due to drug-related adverse events (RR, 0.14; 95% CI, 0.12-0.16; P <.001) or lack of effectiveness (RR, 0.36; 95% CI, 0.30-0.44; P <.001).

LMP associated with greater changes to the modified Pain Disability Scale (LSMD, -13.34; P <.001), Quality of Life Impairment by Pain (LSMD, 7.25; P <.001), Quality of Life Physical component (LSMD, 4.85; P <.001), Quality of Life Mental component (LSMD, 3.01; P <.001), and Clinical Pain Phenotype (LSMD, -6.04; P <.001).

At the end of the observation period, more PHN recipients had discontinued use of antidepressants (61% vs 21.2%), antiepileptics (71.9% vs 35.6%), strong opioid analgesics (68.1% vs 33%), rescue medication (76.7% vs 51.3%), nonopioid analgesics (71.7% vs 36.6%), and mild opioid analgesics (73.7% vs 36.2%).

This study may have been limited by not evaluating treatment compliance.

These real-world data indicated that 700 mg of lidocaine delivered via medical plaster was more effective and better tolerated than oral medications for second-line treatment of localized peripheral neuropathic pain.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Überall M, Bösl I, Hollanders E, Sabatschus I, Eerdekens M. Localized peripheral neuropathic pain: topical treatment with lidocaine 700 mg medicated plaster in routine clinical practice. Pain Manag. 2022;12(4):521-533. doi:10.2217/pmt-2021-0117