Cochrane Database Syst Rev. 2014 Jul 24;7:CD010958. doi: 10.1002/14651858.CD010958.pub2.

Topical lidocaine for neuropathic pain in adults

Derry S, Wiffen PJ, Moore RA, Quinlan J.

In a systematic review of randomised, double-blind studies of at least two weeks’ duration, the analgesic efficacy and adverse effects of topical lidocaine for chronic neuropathic pain was evaluated. 12 studies with a total of 508 participants were included, six of which included participants with moderate or severe postherpetic neuralgia (n=280), and six with different neuropathic pain conditions (including trigeminal neuralgia, postsurgical or post-traumatic neuralgia). Topical lidocaine formulations used were 5% plaster, 5% cream, 5% gel, and 8% spray. 10 studies used a cross-over design, and two a parallel-group design. Two studies used enriched enrolment with randomised withdrawal. Seven studies used multiple doses (one to four-week treatment), and five were single dose studies. All studies were reported to be of very low quality and had a high risk of bias due to small size and/or outcome assessments. In all but one study, lidocaine provided better pain relief compared with placebo. Lidocaine was not associated with increased adverse effects or withdrawals. The current findings indicate that the 5% topical lidocaine plaster may be effective in treating neuropathic pain in some patients and is well tolerated in the short term, however there are large ongoing studies which should provide more robust conclusions about both efficacy and adverse effects.

Prepared by Jason Boland