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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)
The aim was to investigate the efficacy of lidocaine iontophoresis for neuropathic pain management in intercostobrachial neuralgia after mastectomy.
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.
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.
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.
Yarnitsky D, Eisenberg E. Neuropathic pain: between positive and negative ends. Pain Forum 1998; 7:241–242.
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.
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.
Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 2003; 104:1–13.
Cavaletti G, Zanna C. Current status and future prospects for the treatment of chemotherapy-induced peripheral neurotoxicity. Eur J Cancer 2002; 38:1832–1837.
Harden N, Cohen M. Unmet needs in the management of neuropathic pain. J Pain Symptom Manage 2003; 25:12–17.
Nelson DA, Landau WM. Intrathecal methylprednisolone for postherpetic neuralgia. N Engl J Med 2001; 344:1019–1022.
Derry S, Lloyd R, Moore RA, McQuay HJ. Topical capsaicin for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2009; 4: CD007393.
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.
Bendinger T, Plunkett N. Measurement in pain medicine. BJA Education 2016; 16:310–315.
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.
Walia NS, Rathore BS, Jalswal AK. Treatment of palmoplanter hyperhidrosis by iontophoresis. Med J Armed Forces India 2000; 56:27–28.
Rai R, Srinivas CR. Iontophoresis in dermatology. Indian J Dermatol Venereol Leprol 2005; 71:236–241.
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.
Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118:289–305.
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.
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.
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.
O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med 2009; 122:22–32.
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.
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.
Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010; 150:573–581.
Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med 2011; 123:134–142.
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.
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.
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.
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.
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.
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.
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.
Gammaitoni AR, Alvarez NA, Galer BS. Pharmacokinetics and safety of continuously applied lidocaine patches 5%. Am J Health-Syst Pharm 2002; 59:2215–2220.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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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
- lidocaine iontophoresis
- pain DETECT questionnaire
- visual analog scale