Lidocaine 5% Medicated Plaster for Spinal Neuropathic Pain

Our plain-English summary of Lidocaine 5% Medicated Plaster for Spinal Neuropathic Pain, by U. Freo, F. Ambrosio, M. Furnari, et al (Journal of Pain & Palliative Care Pharmacotherapy, 2016).

The study

• Authors: U. Freo, F. Ambrosio, M. Furnari, C. Ori
• Journal: Journal of Pain & Palliative Care Pharmacotherapy
• Published: 2016;30(2):111-3
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Spinal cord injuries frequently determine central pain symptoms that are difficult to control. The authors present the case of a 67-year-old suffering from a pleural mesothelioma. During the disease course, he developed a paraplegia syndrome from mesothelioma compression of the spinal cord at T4-T5 level. Following spinal decompression surgery, the patient presented an intense at-level, superficial neuropathic pain syndrome with allodynia and hyperalgesia. After systemic pharmacological therapies had failed, treatment with lidocaine 5% plaster was initiated. The superficial neuropathic symptoms almost completely disappeared within a few days. The lidocaine topical treatment was continued for months with durable analgesic effect.

In plain English

This case report described one patient. He was a 67-year-old man followed at an occupational medicine department for past work exposure to asbestos; no fiber type is named. He had desmoplastic pleural mesothelioma and received chemotherapy. The tumor later spread outside the membrane around the spinal cord at the T4 to T5 level, leaving him unable to walk, and surgeons removed it. A few days after surgery he reported superficial pain on the left side of his chest. Over the following weeks it worsened markedly (mean 6, worst 9 on a 0 to 10 scale) and was described as burning and shooting; light touch or clothing hurt. Higher fentanyl was scarcely effective; pregabalin was not effective and not tolerated. A lidocaine 5% skin patch worn 12 to 16 hours a day lowered his mean pain to 1 and worst pain to 3. He used the patch for 160 days in total, with no signs of toxicity observed. He died 6 months later from disease progression. The authors concluded that the patch eased his superficial pain for months.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 67-year-old man with pleural mesothelioma, previously followed at an occupational medicine department for past occupational asbestos exposure. The authors are at Padua University, Italy. No dates are given.
• Exposure: Past professional (occupational) exposure to asbestos; the article does not state the fiber type, job or dose. The treatment studied was a lidocaine 5% medicated plaster (patch) for neuropathic pain after spinal surgery.
• Main results:
  • A video-assisted thoracoscopic biopsy showed desmoplastic mesothelioma. An earlier fine-needle biopsy had been negative for cancer.
  • MRI showed the mesothelioma had spread outside the dura (extradural) at the T4 to T5 level of the spine. The patient underwent T4 to T5 laminectomy and tumor resection.
  • A few days after surgery, the patient reported superficial pain in the left thorax.
  • Over the following weeks, this patient's pain worsened to a mean of 6 and a worst of 9 on a 0 to 10 scale. It was described as burning and shooting, light touch or clothing was painful, and his painDETECT score was 23.
  • Light touch or clothing was painful for this patient.
  • Pregabalin was not effective and was not tolerated in this patient. Increased fentanyl was scarcely effective (mean pain 4, worst pain 8).
  • The lidocaine 5% patch, applied to the area of hyperalgesia for 12 to 16 hours per day, reduced this patient's pain to a mean of 1 and a worst of 3.
  • The patient stopped the patch twice but resumed it soon after because the superficial pain came back. In total he used the patch for 160 days.
  • The authors observed no sign of toxicity from the patch, even though the patient was also receiving chemotherapy and other medical therapy.
  • The patient died 6 months later because of disease progression.
• The authors' conclusion: The authors concluded that, after drug therapy failed, the lidocaine 5% patch attenuated this patient's superficial pain for months. They described it as one of few reported cases of lidocaine 5% patch efficacy on spinal cord injury pain.
• Limitations the authors state:
  • The authors could not rule out that some of the effect came from lidocaine absorbed through the skin into the body rather than from a local effect.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma.

Related studies

• Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression — J.M. Gijtenbeek, H.I. Brouwer, et al. (2002)
• Pain in Malignant Pleural Mesothelioma: A Prospective Characterization Study — N. MacLeod, C. Kelly, et al. (2016)
• Ultrasound guided continuous erector spinae plane block for pain management in pulmonary malignancy — T. Aydın, O. Balaban, et al. (2018)
• Airborne exposure concentrations during asbestos abatement of ceiling and wall plaster — J.H. Lange, K.W. Thomulka (2002)
• Airborne exposure during asbestos abatement of floor tile, wall plaster, and pipe insulation — J.H. Lange (2005)
• Intradural intramedullary spinal cord metastasis due to mesothelioma — M.C. Chamberlain, K.D. Eaton, et al. (2010)

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