Effectiveness, Safety, and Predictors of Response to 5% Lidocaine-Medicated Plaster for the Treatment of Patients With Trigeminal Neuralgia: A Retrospective Study

Abstract

Background: Whether 5% lidocaine-medicated plaster (LMP) is a valuable therapeutic option for the treatment of trigeminal neuralgia (TN) is worth exploring. If LMP is proven effective for TN, positive predictors of the analgesic effects of LMP warrant further investigation. Objective: To evaluate the efficacy and safety of LMP for the treatment of TN, and to explore the predictive factors for the treatment efficacy of LMP. Methods: This is a retrospective and observational study. We analyzed the efficacy of LMP for the treatment of TN between March 2019 and January 2022. The follow-up time was approximately 2 weeks, 1 month, 2 months, and 3 months after LMP treatment. The LMP response was considered the Barrow Neurological Institute (BNI) score of I to III and an improvement in BNI of at least I grade from pretreatment baseline. Univariable and multivariable logistic analyses were performed to identify the predictive factors for LMP response. Results: A total of 103 patients were included and analyzed in this study. LMP was effective in some TN patients, with an efficacy rate of 21.4%, 21.4%, 18.4%, and 16.5% after 2 weeks, 1 month, 2 months, and 3 months of LMP treatment, respectively. The overall adverse event rate associated with LMP was 5.8%, and the reported adverse events were all skin reactions. Facial trigger points (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.07-0.86, P = 0.03) and a lower BNI score (OR = 0.37, 95% CI = 0.07-0.87, P = 0.01) were identified as potential predictors for initial efficacy (2-week follow-up) of LMP treatment. Conclusions and Relevance: LMP has been shown to provide effective and sustained analgesia in some TN patients with minimal risk of systemic adverse reactions. Patients with facial trigger points and mild to moderate pain are more likely to benefit from LMP treatment. Our data suggest that LMP may be an effective treatment option for patients with the aforementioned characteristics of TN.

Lidocaine aerosol sprayed on oral and/or nasal mucosa for the rescue of acute trigeminal neuralgia exacerbations: A retrospective study

“…Besides, the plaster itself may also be a kind of stimuli which could trigger paroxysmal pain. A recent study reported the analgesic effect of 5% LMP for TN patients with the efficacy rate of 21% and patients with facial trigger points are more likely to benefit from LMP treatment (29). While in our study, lidocaine aerosol was sprayed directly to patients’ mucosa without the need to touch the face, and the penetration of drug through mucosa is better than transdermal route, thus contributing to a higher effective rate in patients with and without facial trigger points.…”

Clinical insights into traumatic injury of the inferior alveolar and lingual nerves: a comprehensive approach from diagnosis to therapeutic interventions

“…Given that approval is limited to post-zoster neuralgia, employing this treatment for post-traumatic neuralgia of the trigeminal nerve constitutes an off-label use [ 18 ]. Despite being an off-label use, initial promising studies have emerged, indicating successful treatment outcomes for trigeminal neuralgia [ 73 , 74 ], Hence, 5% lidocaine plasters may be considered as an interesting pharmacological option. The utilization of lidocaine plasters is deemed safe, with an anticipation of minimal side effects, limited to local skin reactions, and no anticipated interactions with other medications.…”

Alleviating effect of lavender (Lavandula angustifolia) and its major components on postherpetic pain: a randomized blinded controlled trial

“…However, patients must take these medications for a long time, thus increasing the risk of adverse effects. For example, TCAs can cause anticholinergic toxicity [ 7 ]; opioids can lead to nausea, vomiting, respiratory depression, constipation, sedation and dependency [ 8 ]; and lidocaine patches can cause skin irritation, skin redness and rash [ 9 ]. Moreover, the pain relief provided by pharmacotherapy is often limited [ 10 ].…”