Treatment of postherpetic neuralgia with 5% topical lidocaine plaster – experience from a small county hospital: case report

Abstract

Postherpetic neuralgia (PHN) characterized by chronic neuropathic pain is a common complication of herpes zoster. We investigated the efficacy, safety and cost of treating refractory chronic neuropathic pain with 5% topical lidocaine plaster (TLP) in a female patient attending pain unit at a small county hospital. An 80-year-old female diagnosed with PHN presented with severe left intercostal allodynia and hyperalgesia up to the root of the fourth to tenth thoracic dermatome. We administered the well established first- and second-line specific medications for PHN, but treatment regimens were not efficient. Then we introduced TLP and analyzed data from initial assessment and throughout follow up of 1313 days. The efficacy of treatment was based on pain severity that was assessed using the Short-Form McGill Pain Questionnaire and the related visual analog scale. In the last two years of observation, significant reduction was recorded in healthcare resource utilization (changes correlated with substantial reduction in direct cost (2012-2013: -425.90 €; and 2013-2014: -1,435 €) and clinically relevant reduction in pain severity. No unusual side effects were observed. In conclusion, treatment of PHN with 5% lidocaine plaster demonstrated efficacy in reducing pain severity and cost of medical care with a satisfactory safety profile. A starting point for future studies should be comparison of different treatment protocols and upgrading the knowledge, especially related to the cost of PHN treatment.

Keywords

• Postherpetic neuralgia
• 5% Topical lidocaine plaster
• Allodynia
• Elderly patient
• Cost