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Lidocain-Pflaster zur Therapie neuropathischer und nichtneuropathischer Schmerzen

Klinische Fallstudie an 87 Patienten

Lidocaine patch for therapy of neuropathic and non-neuropathic pain

A clinical case series of 87 patients

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Zusammenfassung

Hintergrund

Topisches Lidocain-Pflaster (LP) ist bei postherpetischer Neuralgie und anderen fokal-neuropatischen Schmerzen wirksam. Klinische Erfolgsprädiktoren sollten ermittelt werden.

Material und Methoden

Die Krankenakten von 87 Patienten mit neuropathischen (NS) und nichtneuropathischen Schmerzen (NNS), die zusätzlich zur bestehenden Schmerztherapie LP erhalten hatten, wurden retrospektiv ausgewertet. Erfasst wurden die Faktoren Geschlecht, Alter, derzeitige Analgetika, Schmerzlokalisation, unerwünschte Wirkungen und das Vorliegen einer dynamischen Allodynie. Die Auswirkung auf die klinische Schmerzlinderung (bewertet mit einem 5-Punkte-Notenscore) wurden untersucht.

Ergebnisse

Insgesamt 24 von 28 Allodyniepatienten (85,7%) bewerten die LP-Therapie als hilfreich, Patienten ohne Allodynie (n=59, 67,8%) profitierten mit nur 39% signifikant seltener (p<0,001). Die Wahrscheinlichkeit, bei vorhandener Allodynie von LP zu profitieren, lag fast um den Faktor 10 höher als ohne Allodynie (Odds Ratio 9,14). Eine Allodynie ließ sich bei Frauen mit 39,6% deutlich, jedoch nicht signifikant (n.s.) öfter nachweisen als bei Männern (23,1%). 62,5% der Frauen profitierten von LP, Männer nur in 43,6% (n.s.). Bei sehr guter Schmerzlinderung lag in über 60% der Fälle eine Allodynie vor, bei Nonrespondern in weniger als 10%. Die Faktoren Patientenalter, Schmerzlokalisation und Begleitmedikation waren ohne Einfluss auf das Therapieergebnis.

Schlussfolgerung

Patienten mit Allodynie profitierten signifikant häufiger von LP und waren unter Nonrespondern seltener. Etwas häufiger profitierten auch Frauen, bei welchen auch Allodynien tendenziell öfter nachweisbar waren. Geschlechtsspezifische Unterschiede bedürfen weiterer Untersuchungen.

Summary

Background

Topical lidocaine patches (LP) reduce pain in postherpetic neuralgia and other forms of focal neuropathy. The aim of this study was to determine clinical predictors of therapeutic success.

Material and methods

The medical histories of 87 patients with neuropathic (NS) and non-neuropathic pain (NNS) who had received LP as an add-on to their established pain medication were retrospectively analyzed. The variables assessed were gender, age, analgesic co-medication, pain localization, adverse effects and presence of dynamic allodynia. The impact of these variables on the clinical pain-relieving effect (scored on a 5-point scale) was investigated.

Results

A total of 24 out of 28 patients with manifest allodynia scored the therapy with LP as beneficial, patients without allodynia (n=59, 67.8%) profited significantly less frequently with only 39% (p<0.001). The probability of profiting from LP therapy in the presence of allodynia was found to be about tenfold higher compared to patients without allodynia (odds ratio 9.14). Of the 87 patients investigated 48 were female (55.2%). Allodynia was considerably more frequent in women (39.6%) compared to men (23.1%) but this was insignificant. Of the female patients 62.5% responded to LP treatment, compared to only 43.6% of men. In more than 60% of cases rated as very good pain relief allodynia was manifest and in non-responders only in less than 10%. The variables age, pain localization and analgesic co-medication were not related with the success of therapy.

Discussion

Patients with manifest allodynia profited significantly more frequently from LP therapy and were less frequently non-responders. Female patients showed therapeutic success more often together with a higher rate of allodynia.

Conclusions

In the presence of allodynia, in especially of neuropathic origin, LP seems to be an effective and save option for add-on therapy, this being independent from pain localization and age. Gender specific effects however need more systematic investigation.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Erstautor hat Beraterfunktion bei den Firmen Astellas, betapharm, Berlin Chemie, Boehringer Ingelheim, Eisai, Grünenthal, medi Bayreuth und Sanofi Pasteur MSD.

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Authors and Affiliations

  1. Facharztzentrum medicum, Schmerz- und Palliativzentrum, Langenbeckplatz 2, 65189, Wiesbaden, Deutschland

    K.-U. Kern

  2. Mathematisches Institut, Universität Bayreuth, Bayreuth, Deutschland

    M. Kohl

  3. Abteilung für Anästhesiologie und Intensivmedizin, Universität Tübingen, Tübingen, Deutschland

    R.T. Kiefer

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  1. K.-U. Kern
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  3. R.T. Kiefer
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Correspondence to K.-U. Kern.

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Kern, KU., Kohl, M. & Kiefer , R. Lidocain-Pflaster zur Therapie neuropathischer und nichtneuropathischer Schmerzen. Nervenarzt 81, 1490–1497 (2010). https://doi.org/10.1007/s00115-010-3060-2

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