Abstract
This review is based on an idea that the administration of local anesthetics to the skin for the treatment of neuropathic pain can result in different types of analgesic effects depending on the presence or absence of skin anesthesia. There are many reviews on topical local anesthetics that provide pain relief without skin anesthesia, the aim of this review is to analyze studies on neuropathic pain treated with cutaneous anesthesia. The reference list of 369 articles was reduced to 8 publications that met inclusion criteria (presence of anesthetic effect was a requirement). The large magnitude of pain relief and the high consistency of the positive outcomes were commonly reported. With the single skin anesthesia treatment, both separately and collectively, the reviewed publications reported that more than half of the patients had complete pain relief, often lasting much longer (days or weeks) than the anesthesia. However, because the number of reviewed articles is small, and they represent single case reports or case series, no reliable conclusion could be drawn. The question merits investigations designed to provide high strength of evidence.
Highlights
Over the past 50 years a number of attempts have been made to use skin infiltration with local anesthetics for the treatment of herpes zoster and postherpetic neuralgia (PHN) [1]
We reviewed studies on the treatment of neuropathic pain with local anesthetics infiltrated intra- or subdermally
All types of original reports were reviewed; including observational studies, case series, and single case reports evaluating the treatment of neuropathic pain with local anesthetics infiltrated intra- or subdermally and with skin anesthesia induced by topically applied local anesthetics
Summary
Over the past 50 years a number of attempts have been made to use skin infiltration with local anesthetics for the treatment of herpes zoster and postherpetic neuralgia (PHN) [1]. These regimens were combinations of the local anesthetic skin infiltrations with the addition of corticosteroids. With the appearance of various topical formulations of local anesthetics, adequate anesthesia of unbroken skin became an attractive alternative to skin infiltrations [2]. Though Lidocaine Patch 5% does not suppress sensation to light touch or pinprick, it does provide “slight to moderate” pain relief in PHN [3,4,5]. The Campbell commentary for this aticle suggested that the often disappointing clinical effects of the patch might be because of “underdosing” [7]
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