Localized Neuropathic Pain Management

Application Guidelines

The 4% lidocain patch is a effective topical treatment option for localized neuropathic pain and can be applied for up to 12 hours a day on the painful area 1
Up to 3 patches can be applied simultaneously, depending on the size of the painful area 1
The patches should be worn for 12 hours within a 24-hour period and then removed to ensure a 12-hour patch-free period 2, 1
Application can be done on dorsal or plantar surfaces of the affected area 1

Lidocain patches have been shown to be effective in various localized neuropathic pain syndromes, including postherpetic neuralgia 2, painful diabetic polyneuropathy 3, and HIV-associated peripheral neuropathy 4, 5

Minimal systemic absorption, reducing systemic side effects 2
Can be combined with other pain medications to achieve multimodal analgesia 2, 1

Should not be applied to broken or inflamed skin 1
Excessive heat application over areas where lidocain is applied should be avoided, as it can increase systemic absorption 1
Contraindicated in advanced liver failure and known hypersensitivity to amide anesthetics 1
Patients should be monitored for signs of systemic absorption such as dizziness, confusion, and bradycardia 1

If pain relief is insufficient, alternative options can be considered, including gabapentin (100-300 mg starting dose, titrated to 900-3600 mg daily) 6, 7, 3, pregabalin (50 mg three times a day, titrated to 100 mg three times a day) 6, 7, 3, and tricyclic antidepressants (e.g. nortriptyline, desipramine 10-25 mg starting dose, titrated to 50-150 mg) 6, 7, 3
Capsaicin 8% patch can provide pain relief for at least 12 weeks 4

Lidocain patches can be combined with non-pharmacological therapies such as yoga or physical therapy for improved pain management 1
In complex pain syndromes, combination with oral medications such as gabapentin for neuropathic pain components can be considered 1

The American College of Physicians recommends lidocain patches and capsaicin creams as effective topical treatments for localized neuropathic pain, with minimal systemic absorption 8

Capsaicin creams or lotions (0.025% to 0.075%) can help with neuropathic pain, and their mechanism of action involves desensitization of the TRPV1 receptor and reduction of pain mediators like substance P 9

Topical NSAIDs like diclofenac gel (1%) can be helpful for some neuropathic pain, and preparations with camphor or menthol in combination with methylsalicylate (e.g., Bengay, Icy Hot) can provide temporary relief 9

The American Diabetes Association notes that the effectiveness of topical treatments is best for localized pain, not for widespread pain syndromes, and that patients with inadequate pain relief or extensive pain should consult a doctor, as prescription medications like gabapentin, pregabalin, or duloxetine may be more effective 10, 11
The American Diabetes Association also recommends that lidocain patches can be particularly helpful for diabetic patients with neuropathic pain, especially for nighttime foot pain 10

The American College of Physicians designates lidocaine patches as first-line treatment for post-herpetic neuralgia with the 12-hour regimen, demonstrating significant pain reduction at all time points from 4-12 hours compared to vehicle patches using the approved 12-hour protocol, with a number needed to treat (NNT) = 2, indicating excellent efficacy 12
Approximately 60% of patients achieve moderate to complete pain relief with proper 12-hour daily application of lidocaine patches for post-herpetic neuralgia, as supported by controlled trials 12

High-concentration capsaicin 8% patch provides pain relief lasting up to 90 days from single application for neuropathic pain components, as an alternative strategy if lidocaine patches provide inadequate relief 12
Pregabalin (50 mg three times daily, titrate to 100 mg three times daily) can be considered if gabapentin fails to provide adequate pain relief for neuropathic pain components 12