Lidocaine Patches For Neuropathy Pain

Today's post comes from both cancer.org (see link below) and a blog reader/neuropathy patient and discusses the effectiveness of lidocaine patches (sometimes known as Versatis, Lidoderm, or Xylocaine) in treating neuropathic pain. They are generally prescribed for post-herpetic neuralgia but will work on the effects other neurological disorders too. A full explanation of the workings and possible side effects and interactions with other medications can be found in this article from cancer.org. Following that is a short personal experience of using lidocaine patches to relieve neuropathic symptoms.

It is important to remember that not every country has approved the use of lidocaine patches and not every insurance company will pay for them. In the UK and USA, there seem to be few problems but it's worth checking with your own pharmacist or insurance company to see whether they are available and you're covered. Certainly, they clearly work for some people and if they can substitute or reduce other drug treatments, they may well be worth thinking about. Talk to your doctor or specialist.

Lidocaine Patches

(lie-doe-cane)

Trade/other name(s): Lidoderm

Why would this drug be used?

The lidocaine patch is used to help control neuropathic pain (numbness, tingling, burning, shooting, or electric-shock-like pain), such as pain in areas affected by shingles, called post-herpetic neuralgia.
How does this drug work?

Lidocaine blocks the signals from nerve endings, causing numbness in the area where it is applied. Because of this, it is known as a local anesthetic.

Before taking this medicine

Tell your doctor…

If you are allergic to anything, including medicines, dyes, additives, or foods, especially if you have had a problem with similar anesthetics such as procaine, tetracaine, or benzocaine.

If you have any medical conditions such as liver disease (including hepatitis), which may require closer monitoring during treatment.

If you are taking any medicine for an irregular heartbeat. Lidocaine can affect the rhythm of the heart.

If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy.

If you are breast-feeding. Small amounts of this drug pass into breast milk and may affect the baby.

About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.
Interactions with other drugs

Drugs that help stop abnormal heart rhythms, such as disopyramide (Norpace), flecainide (Tambocor), mexiletine (Mexitil), moricizine (Ethmozine), procainamide (Procanabid, Pronestyl), propafenone (Rhythmol), quinidine (Quinidex), or tocainide (Tonocard), may affect the heart more if given with lidocaine.

If you get other types of local anesthesia, such as from dental work, your body may absorb too much, which can cause side effects.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

This drug comes in the form of a sticky patch, about 4 by 5 ½ inches in size. When ready to use, take it out of its child-resistant wrapper, remove the liner, and apply it to the most painful area of skin. Apply only to intact skin. Do not place on skin that is inflamed, broken, cut, or irritated in any way. The patch can be left on up to 12 hours out of each 24-hour period.

Before its protective liner is removed, a patch may be cut into smaller pieces if needed. Cut the patches to the size and shape to cover the most painful areas. Talk to your doctor about how many patches to use. Most people can use up to 3 patches at one time if the painful area is large. It is OK to wear clothes over the patch.

After you take off a patch, fold it over on itself so that it sticks together. Throw the used patches away out of the reach of children, pets, and others. If a new or used patch is chewed or swallowed, it can cause serious harm.

Wash your hands after you handle any patch. Be careful not to touch your eyes until your hands are clean. Do not let the patch or liner touch your eye. If any of the medicine gets into your eye, flush with water or saline and protect it until the feeling returns.

Use this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Keep the unused patches in their original child-resistant wrap with the zipper seal closed, out of the reach of children and pets.

Precautions

If you notice burning, irritation, swelling, redness, blistering, or peeling where you have applied the patch, remove the patch and wait until the problem has gone away before re-applying. Usually this takes a few minutes to a few hours.

Because very little of the medicine in the patch is absorbed into the body, the lidocaine patch has few side effects. If it is applied to broken skin, or if for some reason more medicine is absorbed, it can cause lightheadedness, blurred vision, tremors, numbness of other parts of your body, vomiting, and other symptoms. Remove the patch and call your doctor if this happens to you.

Allergic reactions with symptoms like trouble breathing, itching, skin welts (hives), dizziness, faintness, and swelling of the face, mouth, or throat rarely occur. If you have any of these symptoms, get emergency help.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Less common

rash or swelling at the patch site
abnormal feeling at patch site
dizziness
headache
nausea
Rare
allergic reaction, with swelling of the face or throat, trouble breathing*
blurred vision*
tremors*
vomiting*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.
FDA approval

Yes – patch form first approved in 1999.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

http://www.cancer.org/treatment/treatmentsandsideeffects/guidetocancerdrugs/lidocaine-patch

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Personal experience of a neuropathy sufferer

"Lidocaine works very well for me, not in gel form though but on a 'plaster' but, there is always a 'but'...it can only be used for 12 hours at a time...but it's better than nothing

I have been using them for about 2 years now. They are on Prescription and they are free on our NHS....the equivalent of insurance.

A maximum of 3 plasters can be used at any one time....I usually use two...They can only be used for 12 hours at a time because they are cocaine based after all and are sodium channel blockers....prolonged use can affect the heart causing irregular heart rhythm...

You wait 12 hours....it's 12 hours on and 12 hours off. They really help at night!

The strength is standard...5%

I use them on the legs....using them on the feet does work but it is messy....I notice relief within half an hour....but prolonged use gives quicker relief....usually between 2 - 4 weeks."

Nigel (via e-mail)

...........................................................................................

Substitutes For Lidocaine Patches For Kids With Neuropathy

Today's post from ask.metafilter.com (see link below) is taken from a forum discussion on finding an alternative for lidocaine patches to use with children living with neuropathy. Here the aim is to find cheaper options but lidocaine patches can also be too strong for smaller children. The responses to the original question are shown below. We often forget that children can also suffer from neuropathy and although it is less frequent, the pain and sicomfort can be every bit as difficult to deal with. Children aren't as able to rationalise their pain as adults are, so treating them 'kindly' with our medications is very important.

Lidocaine patch substitute for child's neuropathy.
September 25, 2014 
 
Looking for a cool (as in chilly), inexpensive, gel-like patch to replace Lidocaine patches for a child with nerve pain.

Little Orsonet, who is 7, has small nerve fiber neuropathy which manifests as a burning sensation in her feet. The pain varies in intensity and is not present all the time. Her neurologist just prescribed Lidocaine patches, which we tried today and she loves them.

Yeah! However, they are $8 a patch ($240 for a month's supply of the generic) and Medicaid doesn't pay for them. She's on Medicaid because she was adopted through foster care. I have a hunch that what she likes about them is the cool gooeyness (sp?) rather than the actual lidocaine and I'd like to test that hypothesis by finding a patch that I can buy over-the-counter for, hopefully, a lot less money.

I found this on Amazon, but it's basically the same price. I've looked at pain patches, but some of them contain aspirin (a no-no) and most of them appear to lack the cooling gel goodness. Anyone have any suggestions? A worried mom appreciates any input.

If it's relevant, she takes 5 ML of Gabapentin twice a day and Tramadol as needed. posted by orsonet to Health; Fitness (11 answers total) 3 users marked this as a favorite

They aren't super cheap, but they are cheaper than that and can be reused: lansinoh soothing gel breast pads intended for nursing mothers.
posted by bq at 5:48 PM on September 25 [1 favorite]

Will she be walking on them (or at least walking on them a lot), or is it something she does with her feet up?
posted by Lyn Never at 5:56 PM on September 25

What about Biofreeze? Its not a patch, but I would use those exact adjectives (cool and gooey) to describe the sensation.
posted by Nickel Pickle at 5:57 PM on September 25 [1 favorite]

She doesn't need to be able to walk on them.
posted by orsonet at 6:00 PM on September 25

there are menthol gel patches you can buy in the drugstore, and they are indeed cool and gooey.
posted by The Elusive Architeuthis at 6:03 PM on September 25 [1 favorite]

I immediately thought of BioFreeze too. I have chronic wrist pain and use it frequently and it sounds like what you describe.
posted by kbanas at 6:09 PM on September 25 [1 favorite]

FWIW the ones you linked to are $6.99 for a four-pack, not per patch.
posted by celtalitha at 8:05 PM on September 25 [1 favorite]

The methanol gel patches that I like are Salon Pas. They are pretty cheap, and they give a cool feeling.
posted by heathrowga at 8:08 PM on September 25 [1 favorite]

Thanks everyone!
posted by orsonet at 3:53 AM on September 26 

http://ask.metafilter.com/269052/Lidocaine-patch-substitute-for-childs-neuropathy

Can Cannabis Pain Patches Solve Nerve Pain Problems

Today's post from international-highlife.com (see link below)takes another look at medicinal cannabis patches, which are of course, theoretically the ideal treatment for neuropathy sufferers and others who don't want to smoke cannabis, or find the oils too messy when the bottle's nearly empty. It's important to highlight the difference between cannabis patches containing THC and those with CBD as their primary constituent. Many people just don't want to get high or lose control, especially when they're dealing with chronic pain. These people need to look for a high CBD content and a low THC element - you won't get a 'high' feeling from that but you will get optimal analgesic effect. Research has suggested though, that the most effective CBD oil for instance, is that which includes some THC as well as CBD. That may also be the case with trans-dermal patches. The article explains the current state of affairs regarding cannabis patches and their availability and that remains (in 2017) fairly limited. It does leave you wondering why the market for cannabis patches hasn't exploded though. They seem to be the ideal medicinal cannabis vehicle, especially for pain sufferers, who need a long-release system to work best and yet, they aren't being manufactured world-wide as yet. Is this because they are not so effective as first thought, or is it just a question of the right companies finding the right investment to go ahead and market on a wide scale? We have to remember that apart from a few enlightened regions, medicinal cannabis remains somewhat 'off the grid' as far as official approval goes. Time will tell what develops regarding these patches but an interesting read nevertheless.

Next Hype: Cannabis Pain Patches
Seshata Posted 3 weeks ago

One of the hottest new medicinal cannabis products available today is the transdermal pain patch – so what are they, do they work, HOW do they work, and where can I buy one?

 Let’s take a look at the facts!

Right now various media outlets are heavily publicising the cannabis pain patch designed and produced by Cannabis Science, Inc. – a bioscience company based in Colorado Springs, Colorado.

But they’re not the first company to produce cannabis pain patches – in fact, another Colorado based company, Mary’s Medicinals, developed a transdermal cannabis patch back in 2013, which is now being distributed to patients in at least six US states!
 
So What Are Cannabis Transdermal Patches?

Cannabis pain patches are simple adhesive squares of medical gauze infused with cannabinoids. They have a porous layer between the skin and the cannabinoids that allows for controlled, sustained release of the cannabinoids into the skin. It’s not exactly clear how Cannabis Science, Inc. or Mary’s Medicinals make their patches – but online research gives us a few clues.

In order for a patch to deliver medicines effectively through the dermis (skin), the medicine is usually dissolved in an alcohol such as isopropyl. Isopropyl alcohol is commonly known as “rubbing alcohol” as it’s often used to help deliver medicines into the bloodstream.

For centuries, doctors and herbalists have made remedies by infusing active ingredients into alcohol to make a tincture, then rubbing it on the skin. Cannabis is one of hundreds of plants that humans have used in this way throughout history!

Makers of cannabis transdermal patches take it a couple of steps further, and put that dissolved cannabinoid tincture onto a square of adhesive medical gauze. But it’s not quite that simple – as well as dissolving the active ingredient in alcohol, it seems that to make a transdermal patch really effective, you have to add a compound that helps get through the barrier of the skin.

A compound that is very commonly used in making transdermal patches is Dimethyl sulfoxide (DMSO). Forums suggest that to make a transdermal patch, all that’s needed is a few drops of DMSO, added to the tincture and thoroughly mixed.

If you’re hoping to buy cannabis transdermal patches infused with THC, you’ll need to be a registered medical cannabis patient in a legal US state. But if it’s CBD you need, you’re in luck – you can buy Mary’s Medicinals CBD transdermal patches online!

Transdermal patches are reported to be very effective, and any past safety issues have mostly arisen because the medicines inside the patch are dangerous or even deadly if taken at the wrong dosage.

For example, Johnson and Johnson had to recall their Fentanyl patches in 2009 as the porous layer broke down and released the contents too quickly, causing overdose and even death. But cannabinoids are remarkably safe and non-toxic (especially compared to opioids!), so this is not likely to be an issue!

https://international-highlife.com/next-hype-cannabis-pain-patches/

Capsaicin Patches At 8 Approved For Nerve Pain Problems

Today's short post from painweek.org (see link below) reports that a new study (supported by the makers of the patch) has shown that another group of neuropathy patients (in this case, diabetes patients) will benefit from 8% capsaicin patches (for instance Qutenza) and will suffer less pain and better sleep patterns. These patches are nothing new of course but previously, certain neuropathy groups have been excluded from official recommendations. Capsaicin has certainly been proved to be one of the few effective treatments against nerve pain but it's not easy to administer and patients need to watch out for burn and other skin reaction problems. Many people currently use capsaicin creams, or other strength capsaicin patches but the evidence seems to suggest that the strong ones (8%) are the most effective. Worth talking to your doctor about if you haven't tried them before but you will need careful control! More articles concerning capsaicin to be found by using the search button to the right of this blog.
 

Study Supports EU Action to Extend Approval of Capsaicin Patch to Include DPN
October 2015

Results of a phase 3 study presented last month at the European Association for the Study of Diabetes (EASD) 2015 Meeting in Stockholm found that patients with diabetic peripheral neuropathy who received a capsaicin 8% patch experienced more complete pain relief and better sleep quality than those who received a placebo patch. The study was supported by Astellas Pharma Europe, which also announced at the meeting that the patch had received approval in the European Union for the additional indication of the treatment of adult diabetes patients with peripheral neuropathic pain, either alone or in combination with other pain treatments.

The capsaicin patch had previously been approved for use in the EU for neuropathic pain, and in the United States is approved for the treatment of postherpetic neuralgia, but this label doesn’t include diabetes patients. At the EASD meeting, Malcolm Stoker, PhD, global medical lead at Astellas Pharma Global Development, the Netherlands, presented the findings of the randomized, placebo-controlled, double-blind STEP trial involving 369 participants to gauge the efficacy and safety of the patch, a dermal delivery system containing 8% capsaicin, vs placebo, following patients for 12 weeks. According to Dr. Stoker, the study found that the cohort receiving the capsaicin 8% patch reported a statistically significant improvement in pain relief and sleep quality compared with the cohort receiving a placebo patch, and that the capsaicin patch “was well-tolerated, and safety was consistent with previous studies in postherpetic neuralgia and HIV-associated neuropathy.”

To read more about techniques to combat DPN, click here.

To view a slide presentation on DPN, click here.

A news story about the above study findings, with reference to additional information from the presentation, may be read here.

Can a vegan diet improve neuropathy pain? Read an article here, and a Pain Reporter interview with lead researcher of this study, here.

http://www.painweek.org/news_posts/study-supports-eu-action-to-extend-approval-of-capsaicin-patch-to-include-dpn/