Kern K-U, Kohl M, Kiefer R T
Facharztzentrum medicum, Schmerz- und Palliativzentrum, Langenbeckplatz 2, 65189, Wiesbaden.
Nervenarzt. 2010 Dec;81(12):1490-7. doi: 10.1007/s00115-010-3060-2.
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.
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.
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.
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.
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.
局部用利多卡因贴片（LP）可减轻带状疱疹后神经痛及其他形式的局灶性神经病变的疼痛。本研究旨在确定治疗成功的临床预测因素。
回顾性分析87例接受LP作为既定疼痛药物辅助治疗的神经性疼痛（NS）和非神经性疼痛（NNS）患者的病史。评估的变量包括性别、年龄、联合使用的镇痛药、疼痛部位、不良反应及动态性痛觉过敏的存在情况。研究这些变量对临床疼痛缓解效果（采用5分制评分）的影响。
28例有明显痛觉过敏的患者中，共有24例认为LP治疗有益，而无痛觉过敏的患者（n = 59，67.8%）获益明显较少，仅为39%（p < 0.001）。发现存在痛觉过敏时从LP治疗中获益的概率比无痛觉过敏的患者高约10倍（优势比9.14）。在87例被调查患者中，48例为女性（55.2%）。女性中痛觉过敏的发生率（39.6%）明显高于男性（23.1%），但差异无统计学意义。女性患者中62.5%对LP治疗有反应，而男性仅为43.6%。在超过60%被评为疼痛缓解非常好的病例中存在明显痛觉过敏，而在无反应者中痛觉过敏发生率不到10%。年龄、疼痛部位和联合使用的镇痛药等变量与治疗成功与否无关。
有明显痛觉过敏的患者从LP治疗中获益的频率明显更高，无反应者较少。女性患者治疗成功的情况更常见，同时痛觉过敏发生率也更高。
在存在痛觉过敏尤其是神经性痛觉过敏的情况下，LP似乎是一种有效的辅助治疗选择，且与疼痛部位和年龄无关。然而，性别特异性效应需要更系统的研究。
