Casale R.,Research and Care Institute |
Mattia C.,University of Rome La Sapienza
Therapeutics and Clinical Risk Management | Year: 2014
Within the broad definition of neuropathic pain, the refinement of clinical diagnostic procedures has led to the introduction of the concept of localized neuropathic pain (LNP). It is characterized by consistent and circumscribed area(s) of maximum pain, which are associated with negative or positive sensory signs and/or spontaneous symptoms typical of neuropathic pain. This description outlines the clinical features (currently lacking in guidelines and treatment recommendations) in patients for whom topical targeted treatment with 5% lidocaine-medicated plaster is suggested as first-line therapy. Few epidemiologic data are present in the literature but it is generally estimated that about 60% of neuropathic pain conditions are localized, and therefore identifiable as LNP. A mandatory clinical criterion for the diagnosis of LNP is that signs and symptoms must be present in a clearly identified and defined area(s). Cartographic recordings can help to define each area and to assess variations. The diagnosis of LNP relies on careful neurological examination more than on pain questionnaires, but it is recognized that they can be extremely useful for recording the symptom profiles and establishing a more targeted treatment. The most widely studied frequent/relevant clinical presentations of LNP are postherpetic neuralgia, diabetic neuropathy, and neuropathic postoperative pain. They successfully respond to treatment with 5% lidocaine-medicated plaster with equal if not better pain control but with fewer side effects versus conventional systemic treatments. Generally, the more localized the pain (ie, the area of an A4 sheet of paper) the better the results of topical treatment. This paper proposes an easy-to-understand algorithm to identify patients with LNP and to guide targeted topical treatments with 5% lidocaine medicated plaster. © 2014 Casale and Mattia.
Kopsky D.J.,Institute for Neuropathic Pain |
Hesselink J.M.K.,Robert Bosch GmbH |
Bhaskar A.,Leeds Teaching Hospitals NHS Trust |
Hariton G.,Center for Pain Management |
And 2 more authors.
Minerva Anestesiologica | Year: 2015
Topical analgesics may play an important role in the management of chronic pain and have good tolerability. Systemic ketamine has limited usage as an anesthetic and along with its potential for addiction and dependence has not gained popularity as an analgesic compound. Topical ketamine however, is devoid of serious side effects, and thus can be used in the management of various pain states such as neuropathic pain and complex regional pain syndrome. Despite using high concentrations of topical ketamine, clinically significant side effects are rare. The measured plasma levels of ketamine and norketamine in various studies were mostly below the threshold of detection. Topical ketamine has been used as compounded formulations alone in concentrations from 0.5% to 20% or in combination with other (co-)analgesics. Its efficacy may depend on the choice of vehicle, the concentration and the pain state. Suboptimal concentration of ketamine and suboptimal pharmaceutical properties of the cream base might have contributed to the negative results of some studies. In this article we will review clinical studies involving the use of topical ketamine for pain. COPYRIGHT© 2015 EDIZIONI MINERVA MEDICA.