Lidoderm patch herniated discs
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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A herniated disc, sometimes, but incorrectly, called a slipped disc, is one of the most common cause of severe back pain and sciatica.
A disc in the lumbar area becomes herniated when it ruptures or thins out and degenerates to the point that the nucleus pulposus (the gel within the disc) balloons outward through the tough layer that encloses it called the annulus fibrosis. Experts have defined the degree of disc events as follows:
• A bulge (the gel has been pushed out slightly from the disc and is evenly distributed around the circumference).
• Protrusion (the gel has pushed out slightly and asymmetrically in different places).
• Extrusion (the gel balloons into the area outside the vertebrae).
Evidence is now pointing to an immune response in the cells of the nucleus pulposus that may be responsible for nerve injury and pain. The nucleus pulposus in the herniated disc overproduces factors known as cytokines that cause inflammation and cell damage.
Regardless of mechanism, pain due to low back mechanical dysfunction is common and can present a difficult therapeutic problem. Among the many treatments used have been local therapies (ice, heat), anti-inflammatory drugs, narcotics, epidural steroid injections, facet blocks, physical therapy, massage, chiropractic, and so on. One type of treatment that has been used is a patch containing the local anesthetic, lidocaine.
Use of Lidocaine Patch 5% for Chronic Low Back Pain: A Report of Four Cases.
Robert Hines, MD, Diane Keaney, RN, BSN, Michael H. Moskowitz, MD, and Steven Prakken, MD.
Lidocaine, a local anesthetic, is available in patch form (Lidoderm) and has been used specifically for herpes zoster pain. Early studies are suggesting that it may provide significant relief for people who suffer from low back pain with very few adverse effects, even with continuous use of four patches a day. If further studies support its benefits, the patch could prove to be an important treatment.
Objective. To describe the use of the lidocaine patch 5% (Lidoderm®), a targeted peripheral analgesic, in treatment of patients with chronic low back pain.
Design. This retrospective case series examines four patients with pain secondary to spinal degeneration and complications from failed back surgery syndrome, who were prescribed the lidocaine patch as an add-on to their analgesic regimen.
Setting. Bay Area Pain Medical Associates, Mill Valley, California.
Patients. Patients (age range: 33 64 years) were all complicated cases in which multiple analgesics had been prescribed with varying degrees of success.
Intervention. Lidocaine patch 5%.
Results. The addition of the lidocaine patch helped relieve varying characteristics of pain, including general pain, shooting pain, burning pain, and allodynia, and had a significant impact on the quality of life of all patients. Some patients were able to reduce or altogether stop some medications. No adverse events were reported from the lidocaine patch.
Conclusions. Based on our experience with the four cases presented here and with other patients in our clinic, we believe that addition of the lidocaine patch 5% to the analgesic regimen in chronic low back pain may be beneficial. Prospective, controlled clinical trials are planned to further evaluate the efficacy and safety of the lidocaine patch for treatment of chronic low back pain with or without a neuropathic component.
New Data Reveal the Analgesic Patch Lidoderm(R) May Improve Pain Intensity and Common Pain Qualities Associated with Low-Back Pain and Osteoarthritis
Lidoderm(R) is a targeted topical analgesic patch that is applied directly to intact skin. Lidoderm(R) was approved by the FDA in 1999 for relief of pain associated with post-herpetic neuralgia (PHN), a chronic pain that can result from nerve damage by the herpes zoster virus, commonly referred to as shingles. Endo has ongoing placebo-controlled studies of Lidoderm(R) in the treatment of low back pain and osteoarthritis.
"We are constantly looking for new and innovative ways to help patients relieve chronic pain," explains Joseph S. Gimbel, M.D., Arizona Research Center, Phoenix, Ariz., one of the principal investigators in the low back pain study. "The topical analgesic Lidoderm(R) is an innovative treatment for PHN that is effective and well-tolerated. I am encouraged by these new studies that suggest Lidoderm(R) may also offer pain relief for patients who suffer from low back pain and osteoarthritis, and look forward to evaluating Lidoderm(R) in placebo-controlled studies for these indications."
Lidoderm(R) and Low Back Pain
Low back pain is a complex and difficult to treat condition that is associated with significantly decreased quality of life and may require several different treatments for optimal pain relief. It is estimated that more than 17 percent of the work force is affected by low back pain with direct and indirect costs exceeding $50 billion per year.
The six-week, open-label, parallel-group pilot study that was presented evaluated the effectiveness of Lidoderm(R) on distinct and common pain qualities present in low back pain using the Neuropathic Pain Scale (NPS), a validated assessment tool that measures distinct components of pain.
The study was performed at eight sites in the United States, and patients were stratified based on duration of low back pain (group 1: acute/subacute low back pain; group 2: short-term chronic low back pain; group 3: long-term chronic low back pain). In the first two weeks of the study, patients were maintained on pre-existing treatment regimens with no dose alterations or additions other than the Lidoderm(R) patch.
Beginning on day 14, concomitant analgesics could be tapered by 25% of total daily dose, every five days, for patients who reported a daily pain intensity score less than or equal to four on a scale of 0 (no pain, not sensitive to individual pain descriptors) to 10 (most severe pain, most sensitive to individual pain descriptors).
Effectiveness was measured by the change from baseline to week six in the ten specific NPS pain qualities. In the total patient population analyzed, the study showed that six weeks of treatment with Lidoderm(R) significantly improved all individual NPS composite measures (p<.001) with the exception of "cold", "sensitive" and "itchy" which were rated as mild at baseline.
In the three patient subgroups, significant improvements were noted for the following pain qualities after six weeks of treatment: group 1, significant improvements were reported for
"sharp", "dull", "deep", and "surface" pain (p<.05), as well as for overall pain "intensity" and overall "unpleasantness" (p=.001); group 2, significant improvements were noted for "surface" pain (p=.009) and for overall pain "intensity" and "unpleasantness" (p<.05); group 3, significant improvements were noted for all pain qualities (p<.05) with the exception of "cold" pain. Treatment was well tolerated overall.
The most commonly reported treatment-related adverse events were skin-related, such as rash, and were categorized as mild-to-moderate.
"There is a critical need to develop effective and well-tolerated new approaches to treating chronic low back pain in this enormous patient population," said Dr. Gimbel. "Promising data from this study suggest Lidoderm(R), used as either monotherapy or adjunctive therapy, may alleviate acute and chronic low back pain, but additional placebo-controlled studies are needed to confirm this observation."
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