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Lidocaine iontophoresis for postmastectomy intercostobrachial neuralgia: single-blinded randomized controlled trial

Bulletin of Faculty of Physical Therapy volume 24, pages 32–39 (2019)Cite this article

Abstract

Aim

The aim was to investigate the efficacy of lidocaine iontophoresis for neuropathic pain management in intercostobrachial neuralgia after mastectomy.

Design

A single-blinded randomized controlled trial was conducted.

Patients and methods

A total of 40 patients with partial or radical mastectomy were randomly divided into two equal groups: group A (lidocaine iontophoresis) and group B (lidocaine patch). The methods of assessment included visual analog scale (VAS) and pain DETECT questionnaire. Group A received lidocaine iontophoresis day after day for 4 weeks. Group B received lidocaine 5% patch (LIDODERM) onto the painful area for 12 h daily. Treatment program extended for 1 month, whereas evaluation was done before and after treatment.

Results

There was no significant difference between both groups in VAS (0.14) and pain DETECT questionnaire (0.32), before treatment. Comparison between groups after treatment revealed a significant reduction in VAS and pain DETECT questionnaire of group A compared with that of group B (P=0.0001). The percent of reduction in VAS of groups A and B was 86.47 and 61.11%, respectively, whereas the percent of reduction in pain DETECT questionnaire was 76 and 49.57%, respectively.

Conclusion

It was concluded that lidocaine iontophoresis was safe and effective method for intercostobrachial neuralgia management after mastectomy in expression of decreasing pain intensity and quality.

References

  1. Yarnitsky D, Eisenberg E. Neuropathic pain: between positive and negative ends. Pain Forum 1998; 7:241–242.

    Google Scholar 

  2. Attal N, Lanteri-Minet M, Laurent B, Fermanian J, Bouhassira D. The specific disease burden of neuropathic pain: results of a French nationwide survey. Pain 2011; 152:2836–2843.

    PubMed  Google Scholar 

  3. Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain 2016; 157:1599–1606.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 2003; 104:1–13.

    PubMed  Google Scholar 

  5. Cavaletti G, Zanna C. Current status and future prospects for the treatment of chemotherapy-induced peripheral neurotoxicity. Eur J Cancer 2002; 38:1832–1837.

    CAS  PubMed  Google Scholar 

  6. Harden N, Cohen M. Unmet needs in the management of neuropathic pain. J Pain Symptom Manage 2003; 25:12–17.

    Google Scholar 

  7. Nelson DA, Landau WM. Intrathecal methylprednisolone for postherpetic neuralgia. N Engl J Med 2001; 344:1019–1022.

    CAS  PubMed  Google Scholar 

  8. Derry S, Lloyd R, Moore RA, McQuay HJ. Topical capsaicin for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2009; 4: CD007393.

    Google Scholar 

  9. Katz NP, Gammaitoni AR, Davis MW, Dworkin RH. Lidoderm Patch Study Group. Lidocaine patch 5% reduces pain intensity and interference with quality of life in patients with postherpetic neuralgia: an effectiveness trial. Pain Med 2003; 3:324–332.

    Google Scholar 

  10. Bendinger T, Plunkett N. Measurement in pain medicine. BJA Education 2016; 16:310–315.

    Google Scholar 

  11. Abu-Shaheen A, Yousef S, Riaz M, Nofal A, AlFayyad I, Khan S, Heena H. Testing the validity and reliability of the Arabic version of the painDETECT questionnaire in the assessment of neuropathic pain. PLoS One 2018; 13:1–13.

    Google Scholar 

  12. Walia NS, Rathore BS, Jalswal AK. Treatment of palmoplanter hyperhidrosis by iontophoresis. Med J Armed Forces India 2000; 56:27–28.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Rai R, Srinivas CR. Iontophoresis in dermatology. Indian J Dermatol Venereol Leprol 2005; 71:236–241.

    PubMed  Google Scholar 

  14. Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C, Ali H. Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004; 63:959–965.

    CAS  PubMed  Google Scholar 

  15. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118:289–305.

    CAS  PubMed  Google Scholar 

  16. Attal N, Cruccu G, Haanpää M, Hansson P, Jensen TS, Nurmikko T, et al. EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006; 13: 1153–1169.

    CAS  PubMed  Google Scholar 

  17. Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007; 132:237–251.

    CAS  PubMed  Google Scholar 

  18. Acevedo JC, Amaya A, Casasola Ode L, Chinchilla N, De Giorgis M, Florez S, et al. Guidelines for the diagnosis and management of neuropathic pain: consensus of a group of Latin American experts. J Pain Palliat Care Pharmacother 2009; 23:261–281.

    PubMed  Google Scholar 

  19. O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med 2009; 122:22–32.

    Google Scholar 

  20. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17:1113–1123.

    CAS  PubMed  Google Scholar 

  21. Dworkin RH, O’Connor AB, Audette J, Baron R, Gourlay GK, Haanpää ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010; 85:3–14.

    Google Scholar 

  22. Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010; 150:573–581.

    PubMed  Google Scholar 

  23. Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med 2011; 123:134–142.

    PubMed  Google Scholar 

  24. Fernández R, Ahumada M, Muñoz R, Urra X, Yáñez MV, Velasco MO, Aguayo C, et al. Guidelines for definition and management of localized neuropathic pain (LNP): Chilean consensus. Revista El Dolor 2011; 55:12–31.

    Google Scholar 

  25. Wolff RF, Bala MM, Westwood M, Kessels AG, Kleijnen J. 5% lidocaine-medicated plaster vs other relevant interventions and placebo for postherpetic neuralgia (PHN): a systematic review. Acta Neurol Scand 2011; 123:295–309.

    CAS  PubMed  Google Scholar 

  26. Harden RN, Kaye AD, Kintanar T, Argoff CE. Evidence-based guidance for the management of postherpetic neuralgia in primary care. Postgrad Med 2013; 125:191–202.

    PubMed  Google Scholar 

  27. Kamalipour H, Ahmadi S. Local infiltration of lidocaine versus lidocaine iontophoresis in pain relief during radial artery cannulation for open heart surgery. IRCMJ 2007; 9:133–138.

    Google Scholar 

  28. Gangarosa LP Sr, Ozawa A, Ohkido M, Shimomura Y, Hill JM. Iontophoresis for enhancing penetration of dermatologic and antiviral drugs. J Dermatol 1995; 22:865–875.

    PubMed  Google Scholar 

  29. Krumova E, Zeller M, Westermann A, Maier C. Lidocaine patch (5%) produces a selective, but incomplete block of Adelta and C fibers. Pain 2012; 153:273–280.

    CAS  PubMed  Google Scholar 

  30. Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M. 5% lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy: an openlabel, non-inferiority two-stage RCT study. Curr Med Res Opin 2009; 25: 1663–1676.

    CAS  PubMed  Google Scholar 

  31. Gammaitoni AR, Alvarez NA, Galer BS. Pharmacokinetics and safety of continuously applied lidocaine patches 5%. Am J Health-Syst Pharm 2002; 59:2215–2220.

    CAS  PubMed  Google Scholar 

  32. Baliki MN, Geha PY, Jabakhanji R, Harden N, Schnitzer TJ, Apkarian AV. A preliminary fMRI study of analgesic treatment in chronic back pain and knee osteoarthritis. Mol Pain 2008; 4:47.

    PubMed  PubMed Central  Google Scholar 

  33. Wasner G, Kleinert A, Binder A, Schattschneider J, Baron R. Postherpetic neuralgia: topical lidocaine is effective in nociceptor-deprived skin. J Neurol 2005; 252:677–686.

    CAS  PubMed  Google Scholar 

  34. Herrmann DN, Panoni V, Barbano RL, Pennella-Vaughan J, Dworkin RH. Skin biopsy and quantitative sensory testing do not predict response to lidocaine patch in painful neuropathies. Muscle Nerve 2006; 33:42–48.

    PubMed  Google Scholar 

  35. Sasao Y, Ozawa A. Postherpetic neuralgia dermatology practice 10: difficult to treat skin diseases. In: Hashimoto K. et al., editors. Bunkodo, Tokyo. 2000; pp. 110–114 (in Japanese).

    Google Scholar 

  36. Ozawa A, Haruki Y, Iwashita K, Sasao Y, Miyahara M, Sugai J, et al. Follow-up of clinical efficacy of iontophoresis therapy for postherpetic neuralgia (PHN). J Dermatol 1999; 26:1–10.

    CAS  PubMed  Google Scholar 

  37. Hans G, Joukes E, Verhulst J, Vercauteren M. Management of neuropathic pain after surgical and non-surgical trauma with lidocaine 5%patches: study of 40 consecutive cases. Curr Med Res Opin 2009; 25:2737–2743.

    CAS  PubMed  Google Scholar 

  38. Garzón-Rodríguez C, Calsina-Berna A, López-Rómboli E, Porta-Sales J. Lidocaine 5% patches as an effective short-term co-analgesic in cancer pain. Preliminary results. Support Care Cancer 2013; 21:3153–3158.

    PubMed  Google Scholar 

  39. Delorme C, Navez ML, Legout V, Deleens R, Moyse D. Treatment of neuropathic pain with 5% lidocaine-medicated plaster: five years of clinical experience. Pain Res Manag 2011; 16:259–263.

    PubMed  PubMed Central  Google Scholar 

  40. Galer BS, Jensen MP, Ma T, Davies PS, Rowbotham MC. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle controlled, 3-week efficacy study with use of the Neuropathic Pain Scale. Clin J Pain 2002; 18:297–301.

    PubMed  Google Scholar 

  41. Uzaraga I, Gerbis B, Holwerda E, Gillis D, Wai E. Topical amitriptyline, ketamine, and lidocaine in neuropathic pain caused by radiation skin reaction: a pilot study. Support Care Cancer 2012; 20:1515–1524.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Pharmacy Syndicate Street, 22511, Damanhour, El Behaira, Cairo, Egypt

    Nancy H. Aboelnour PhD & Walid A. Abouelnaga

Authors
  1. Nancy H. Aboelnour PhD
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  2. Walid A. Abouelnaga
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Correspondence to Nancy H. Aboelnour PhD.

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Aboelnour, N., Abouelnaga, W. Lidocaine iontophoresis for postmastectomy intercostobrachial neuralgia: single-blinded randomized controlled trial. Bull Fac Phys Ther 24, 32–39 (2019). https://doi.org/10.4103/bfpt.bfpt_17_18

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  • DOI: https://doi.org/10.4103/bfpt.bfpt_17_18

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