Treatment of an acute severe central neuropathic pain syndrome by topical application of lidocaine 5% patch: a case report

Abstract

Case report. Metastatic epidural spinal cord compression frequently leads to central neuropathic pain symptoms, which are often difficult to treat. A new treatment option is being presented. Antwerp University Hospital, Belgium. We present the case of a 54-year-old male patient suffering from metastatic pancreatic cancer. During the course of his disease the patient developed a paraplegic syndrome due to metastatic compression of the spinal cord. After surgical decompression was performed, patient developed a severe at-level neuropathic pain syndrome, consisting of dysesthesias and allodynia. After all other pharmacological approaches had failed, treatment with lidocaine 5% patches was initiated. Within 4 h after the first patch application, neuropathic symptoms started to disappear. After 12 h, patient had become completely pain free. This topical treatment was continued during several weeks with lasting analgesic efficacy. This case report indicates that transdermal administration of lidocaine could be potentially useful in the treatment of acute central painful neuropathies. We hypothesize that the transdermal administration of lidocaine induces suppression of ectopic impulses in sensitized cutaneous afferents, leading to some kind of 'dewinding syndrome' in the dorsal horn, which in turn leads to a decrease of painful symptoms.