Journal article for H&P #2: Patient with herpes zoster (shingles)
Title: Effectiveness and safety of lidocaine patch 5% to treat herpes zoster acute neuralgia and to prevent postherpetic neuralgia
Authors: Bianchi L, Piergiovanni C, Marietti R, et al., 2021
Link: https://onlinelibrary-wiley-com.york.ezproxy.cuny.edu/doi/epdf/10.1111/dth.14590
Summary paragraph:
The purpose of this article is to assess the effectiveness and tolerability of using a 5% lidocaine patch in patients with acute neuralgia and postherpetic neuralgia caused by herpes zoster. The study enrolled 38 adults diagnosed with acute neuralgia or postherpetic neuralgia between January and June 2018. A 5% lidocaine patch was applied to affected areas from week 0 to week 8, excluding certain lesion types, after initial pain level measurement. Patients were also provided additional pain relief medications such as acetaminophen along with the lidocaine patch. Pain intensity, LP5% tolerability, and rescue therapy were monitored at W2, W4, and W8.
The results showed that the lidocaine patch effectively relieved pain in both acute and post-herpetic neuralgia groups. The acute pain group exhibited higher effectiveness at 89.5% at week 2, with reduced use of pain medications over time. The post-herpetic neuralgia group had 73% pain improvement by week 2 and tended to rely more on consistent medication use. During weeks 4 to 8, when acute neuralgia progresses towards PHN, most patients in the acute neuralgia group experienced complete pain relief (77.8%), with only a small number needing additional medication. Both groups also required less lidocaine patches over time.
In conclusion, the 5% Lidocaine patch should be prescribed in the early stages of shingles for pain relief because the nerve damage is primarily due to inflammation rather than permanent structural damage. Lidocaine can better control inflammation and nerve function in these early stages, provide mechanical protection and it can also prevent the progression to postherpetic neuralgia. Additionally, lidocaine can reduce the need for additional pain relief medications.
Some strengths of this article include the length of the experiment, inclusion of both genders and examination of several different dermatomes. The 8-week period allowed the author to assess any long-term side effects and the effectiveness of lidocaine in providing long-term relief. And comorbidities that can influence perception of pain such as diabetic neuropathy were excluded. One limitation is the small number of participants. Because only 38 patients took part in the trials, further verification of the findings is necessary before they can be applied to the general population with significance.
