Treatment of Postherpetic Neuralgia With 5% Topical Lidocaine Plaster – Experience From a Small County Hospital: Case Report

Abstract

SUMMARY -Postherpetic neuralgia (PHN) characterized by chronic neuropathic pain is a common complication of herpes zoster. We investigated the effi cacy, 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 fi rst-and second-line specifi c medications for PHN, but treatment regimens were not effi cient. Th en we introduced TLP and analyzed data from initial assessment and throughout follow up of 1313 days. Th e effi cacy 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, signifi cant 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 eff ects were observed. In conclusion, treatment of PHN with 5% lidocaine plaster demonstrated effi cacy in reducing pain severity and cost of medical care with a satisfactory safety profi le. A starting point for future studies should be comparison of diff erent treatment protocols and upgrading the knowledge, especially related to the cost of PHN treatment.

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