Shantou University Medical College, Shantou, Guangdong, China.
Department of Neurology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Pain Physician. 2020 Nov;23(6):541-551.
Postherpetic neuralgia (PHN) is a neuropathic pain that causes a reduction in patients' quality of life. There are many topical drugs for PHN, including topical lidocaine patch, topical application of capsaicin, and others.
This study aims to compare the efficacy and safety of topical drugs for PHN.
Relevant studies were found by systemically searching for terms including "topical" and "Postherpetic neuralgia" in PubMed, Cochrane library, MEDLINE, and EMBASE databases (inception through June 12, 2019). The primary outcome was the percentage of change in the Numeric Rating Scale or the Visual Analog Scale scores from baseline. The secondary outcome was the number of adverse events.
The efficacy and safety of topical drugs for PHN was investigated by the pairwise meta-analysis and Bayesian network meta-analysis, applying Revman 5.3, the Stata 14.0 software, and GeMTC 0.14.3.
Twelve studies met the inclusion criteria, and eligible studies were selected for the ultimate meta-analysis. Our meta-analysis displayed 6 topical drugs for PHN. Lidocaine, high-concentration capsaicin, and aspirin/diethyl ether (ADE) had a higher possibility of bringing pain relief than placebo. Among them, lidocaine had the highest possibility of being the most effective drug for PHN and had the statistical significances compared with diclofenac, high-concentration capsaicin, indomethacin, low-concentration capsaicin, and placebo, and lidocaine was significantly preferable than other effective drugs in the aspect of safety.
(1) The small number of included studies; (2) a small number of patients and short-term trials in progress, including lidocaine and ADE; (3) both randomized controlled trial and crossover randomized trial were included in our network meta-analysis; (4) only studies published in English were evaluated; (5) lack of head-to-head comparisons of some treatments; (6) different measurement methods were used in different trial, which may cause deviation; and (7) with the lack of cycles in the included trials, the inconsistency factors cannot be calculated, and node-splitting method cannot be performed in our network meta-analysis to check the inconsistency.
Compared with other topical drugs, lidocaine was the most effective and most tolerable drug to be recommended for PHN.
带状疱疹后神经痛（PHN）是一种神经病理性疼痛，会降低患者的生活质量。有许多治疗 PHN 的局部药物，包括局部利多卡因贴剂、局部辣椒素贴剂等。
本研究旨在比较治疗 PHN 的局部药物的疗效和安全性。
通过系统检索 PubMed、Cochrane 图书馆、MEDLINE 和 EMBASE 数据库中包含“局部”和“带状疱疹后神经痛”的术语，查找相关研究。主要结局是数字评分量表或视觉模拟量表评分从基线的变化百分比。次要结局是不良反应的发生数。
采用 Revman 5.3、Stata 14.0 软件和 GeMTC 0.14.3 对局部药物治疗 PHN 的疗效和安全性进行配对荟萃分析和贝叶斯网络荟萃分析。
纳入 12 项研究，最终对这些研究进行了荟萃分析。我们的荟萃分析显示有 6 种治疗 PHN 的局部药物。利多卡因、高浓度辣椒素和阿司匹林/乙醚（ADE）比安慰剂更有可能缓解疼痛。其中，利多卡因最有可能成为治疗 PHN 最有效的药物，与双氯芬酸、高浓度辣椒素、吲哚美辛、低浓度辣椒素和安慰剂相比，具有统计学意义，并且在安全性方面优于其他有效药物。
（1）纳入研究数量较少；（2）进行中的试验患者数量较少且试验时间较短，包括利多卡因和 ADE；（3）我们的网络荟萃分析既包括随机对照试验，也包括交叉随机试验；（4）仅评估了发表在英语文献中的研究；（5）缺乏一些治疗方法的头对头比较；（6）不同试验中使用了不同的测量方法，可能会导致偏差；（7）纳入试验中没有周期，无法计算一致性因素，也无法在网络荟萃分析中进行节点分割法来检查不一致性。
与其他局部药物相比，利多卡因是治疗 PHN 最有效、最耐受的药物。
