Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain?

Figures & data

Figure 1 Forty-one case reports of patients with cancer pain with neuropathic components were reviewed.

Abbreviation: CGIC, Clinical Global Impression of Change.

Table 1 Case reports for cancer pain with neuropathic components related to chemotherapy (pain was additionally related to radiotherapy in one patient and to surgery and cancer in another)

Gender /case number	Age	Primary diagnosis (pain indication/cause of pain)	Localization of pain symptoms	Duration of pain in years	Hyper-algesia	Allodynia/ allodynia severity rating	Pain intensity (0–10)	Pain quality	Mono-therapy	Plasters per day	Duration of plaster treatment (months)	CGIC score
M C41	57	Prostate cancer, bone metastases; osteonecrosis of jaw due to chemotherapy	Left chin	<1			5	Stabbing, shooting, like electric discharges very short but intense	N	1/8	1 month, ongoing	1
M C5	60	Lung adenocarcinoma	Mainly feet, thoracotomy	1.5	X	1	4–5	Burning	N	3	2	2
Fa C6	48	Ovarian cancer (post chemotherapy and surgery), other relevant diagnosis: CRPS 1, 2 months after chemotherapy	Hands, mainly right	0.25	X	2	7	Stabbing	N	2	0.5	2
Fa C7	43	CRPS 1 (legs) 3 years post nephrectomy, renal implantation, chemotherapy	Feet	0.83	X	3	8–9	Shooting	Y	3	0.67	2
Mb C8	68	Planoepithelial carcinoma right lung (complete resection and chemo)	Thoracic region (scar)	0.5		1	6	Shooting	Y	1	0.5	2
F C18	60	Chemotherapy oxaliplatin	Hands and feet	1.67			7–8	Tingling	Y	4	NA	2
Mc C25	62	Right lung cancer, pancoast syndrome	Thoracic, neck and arm	0.08		2	8.5	Stabbing, burning, shooting	N	3	NA	2

Notes:

a Pain judged to be cancer-independent;

b pain also related to surgery and cancer;

c pain also related to radiotherapy. Allodynia severity rating: 0 = no pain or discomfort to touch, 1 = uncomfortable, but tolerable to touch, 2 = painful, 3 = extremely painful, patient cannot stand touching; duration of pain was converted to years, the term “months” was set to <1 year in the table and to 0.5 years for calculation of means.

Abbreviations: CGIC, Clinical Global Impression of Change rating during treatment with 5% lidocaine-medicated plaster: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change; CRPS, complex regional pain syndrome; F, female; M, male; NA, not available; N, no; X, symptom present; Y, yes.

Table 4 Case reports for cancer pain with neuropathic components related to cancer (pain was additionally related to radiotherapy in two patients, to surgery in two patients, and to chemotherapy and surgery in one patient)

Gender/case number	Age	Primary diagnosis (pain indication/cause of pain)	Localization of pain symptoms	Duration of pain in years	Hyper-algesia	Allodynia/allodynia severity rating	Pain intensity (0–10)	Pain quality	Mono-therapy	Plasters per day	Duration of plaster treatment (months)	CGIC score
M C10	52	Nociceptive + neuropathic pain/cancer pain/infiltration of the brachial plexus	Neck and arm (right)	4			5–7	Stabbing, burning, shooting, dullness, itch, sensory deficit	N	NA	NA	1
M C37	80	Neuropathic pain, lung neoplasia	Dorsal	5		3	7	Burning, like water falling	N	1	12	1
F C40	82	Bone metastases, colon neoplasia	Dorsal	10	X	2	8	Burning	N	1	18	1
F C33	68	Breast adenocarcinoma, bone metastasis T11 and L1	Dorsolumbar with intercostal irradiation	0.06	X		6	Shooting, like raging toothache	N	1/4 daily for 1st few days then every 2nd day	0.75	1
M C17	71	Neoplastic pain	Right hip	0.67		1	7	Burning	Y	1	4	2
M C34	69	NSCLC right middle lobe	Lombar	0.02	X		7	Burning, shooting	N	1/2	2	2
M C36	69	Bronchogenic cancer (right IIIb → IV)	Scapulalgia	<0.08	X		NA	Shooting	N	1/4	3	2
F C15	47	Uterus sarcoma, intra/retroperitoneal filiae	Left lower leg	0.25		3	8	Stabbing, burning	N	2	2	2
Fa C1	54	Meningioma of right cavernous sinus with oculomotor failure (III and IV nerve paralysis) and loss of visual acuity	Right frontoparietal headache (hemicrania)	7	X	2	2–3	Stabbing, burning, shooting	N	1	18	2
Mb C29	42	Carcinoma left kidney	Region of postoperative scar	0.007	X	2	9	Stabbing, burning	N	1	1	2
F C12	51	Cancer nociceptive + neuropathic (sigmoide)	Belly, thigh, leg	0.25		2	7	Stabbing, burning, shooting, tightness	N	NA	1	2
F C14	48	Breast cancer left, pulmonal filiae + bone	Left calf due to cancer infiltration of sacrum and S1 root	0.08		1	7	Burning	N	1	>2	2
Mb,c C8	68	Planoepithelial carcinoma right lung (complete resection and chemo)	Thoracic region (scar)	0.5		1	6	Shooting	Y	1	0.5	2
Fb C2	70	Liposarcoma of left kidney	Left psoas + T12	1	X	2	3–4	Dysesthesia	N	2	16	3
F C11	46	Cancer pain metastasis/vertebral T4	Thoracic	10			6–7	Stabbing, burning, shooting	N	3	4	3
F C9	56	Cancer pain nociceptive and neuropathic	Cervicalgies, rachialgies, cruralgies	2			7	Burning	N	NA	NA	3
F C22	89	Metastases in vertebral column	Thoracic spine, radiation to the anterior thoracic wall	0.5	X		6	Stabbing, shooting, numbness in anterior thoracic wall	N	1	1	3
Ma C24	53	Lung cancer, right upper lobectomy	Right thoracic pain post cancer surgery	0.5	X	1	5	Burning, shooting	N	3	NA	4
M C30	74	Prostate carcinoma, bone metastases, stenosis spinalis	Lumbar spine – level L1–L2	0.08	X	1	9	Burning, shooting	N	1	0.5	4
F C31	55	Bone metastases from breast cancer, radiotherapy	Interscapular pain	0.17	X	1	8	Burning	N	1	0.4	4
M C35	69	Adenocarcinoma, right lung superior lobe	Axillar	<0.08		3	7	Shooting	N	1/2	0.1	4

Notes:

a Pain also related to radiotherapy;

b pain also related to surgery;

c pain also related to chemotherapy. Allodynia severity rating: 0 = no pain or discomfort to touch, 1 = uncomfortable, but tolerable to touch, 2 = painful, 3 = extremely painful, patient cannot stand touching; duration of pain was converted to years, the term “weeks” was set to <0.08 in the table and to 0.05 for calculation of means.

Abbreviations: CGIC, Clinical Global Impression of Change rating during treatment with 5% lidocaine-medicated plaster: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change; F, female; M, male; NA, not available; N, no; NSCLC, non-small-cell lung carcinoma; X, symptom present; Y, yes.

Table 2 Case reports for cancer pain with neuropathic components related to radiotherapy (pain was additionally related to surgery in 4 patients, to cancer in 2 patient and to chemotherapy in one patient)

Gender /case number	Age	Primary diagnosis (pain indication/cause of pain)	Localization of pain symptoms	Duration of pain in years	Hyper-algesia	Allodynia/ allodynia severity rating	Pain intensity (0–10)	Pain quality	Mono-therapy	Plasters per day	Duration of plaster treatment (months)	CGIC score
Ma C3	42	Left leg fusiform cell sarcoma	Leg – knee	2	X		4–5	Burning, like an electrical shock	N	1	8	1
F C4	65	Uterus adenocarcinoma	Feet, legs	10	X	2	3–4	Burning	Y	1	3	1
Fb C1	54	Meningioma of right cavernous sinus with oculomotor failure (III and IV nerve paralysis) and loss of visual acuity	Right frontoparietal headache (hemicrania)	7	X	2	2–3	Stabbing, burning, shooting	N	1	18	2
Mc C25	62	Right lung cancer, pancoast syndrome	Thoracic, neck and arm	0.08		2	8.5	Stabbing, burning, shooting	N	3	NA	2
F C27	68	Mesothelioma	Arm and breast	0.25		3	8	Burning	N	3	NA	2
Ma C28	53	Cavum and sinus piriformis carcinoma	Right part of neck	0.33	X	2	7	Burning, shooting	N	2	NA	2
Fa C26	44	Occipital sarcoma, epidural metastasis, L3 L4 L5 metastases	L3 radicular pain	0.06			6		N	3	NA	3
Mb C24	53	Lung cancer, right upper lobectomy	Right thoracic pain post cancer surgery	0.5	X	1	5	Burning, shooting	N	3	NA	4
Fa C20	67	Persistent postmastectomy pain	Chest wall, right side	4		2	8	Burning, shooting	N	1	3	4

Notes:

a Pain also related to surgery;

b pain also related to cancer;

c pain also related to chemotherapy. Allodynia severity rating: 0 = no pain or discomfort to touch, 1 = uncomfortable, but tolerable to touch, 2 = painful, 3 = extremely painful, patient cannot stand touching; duration of pain was converted to years.

Abbreviations: CGIC, Clinical Global Impression of Change rating during treatment with 5% lidocaine-medicated plaster: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change; F, female; M, male; NA, not available; N, no; X, symptom present; Y, yes.

Table 3 Case reports for cancer pain with neuropathic components related to surgery (pain was additionally related to radiotherapy in 4 patients, to cancer in 2 patients, and to chemotherapy and cancer in 1 patient)

Gender /case number	Age	Primary diagnosis (pain indication/cause of pain)	Localization of pain symptoms	Duration of pain in years	Hyper-algesia	Allodynia/ allodynia severity rating	Pain intensity (0–10)	Pain quality	Mono-therapy	Plasters per day	Duration of plaster treatment (months)	CGIC score
Ma C3	42	Left leg fusiform cell sarcoma	Leg – knee	2	X		4–5	Burning, like an electrical shock	N	1	8	1
F C32	44	Right mastectomy and mammae prosthesis	Axilla and inner part of forearm	2.5		1	7	Burning	Y	1 every second day	0.25	1
F C19	74	Postmastectomy	Thorax (scar pain)	1.08	X	2	7–8	Burning, like electric discharge	N	1/2	24 (interrupted)	1
F C23	58	Postthoracotomy pain	Posterolateral (left) +/− 7th rib	0.5		2	7	Shooting	Y	1/2	4	1
M C16	79	Rhabdomyosarcoma thorax surgery (+latissimus plastic reconstruction)	Lateral thorax left	0.33		1 (ventral scar), 2 (dorsal scar)	9	Stabbing, shooting	N	2	5	2
F C38	60	Mastectomy	Scar of breast surgery	3	X	3	9	Burning, shooting	N	1	18	2
Mb C29	42	Carcinoma left kidney	Region of postoperative scar	0.007	X	2	9	Stabbing, burning	N	1	1	2
M C39	56	Thoracic surgery for lung cancer	Dorsal (localization of chest drain)	0.5	X	1	6	Shooting	Y	1/2	2	2
F C13	43	Nociceptive + neuropathic pain posthysterectomy	Vaginal + inguinal	0.08	X		NA	Burning	N	2	NA	2
Ma C28	53	Cavum and sinus piriformis carcinoma	Right part of neck	0.33	X	2	7	Burning, shooting	N	2	NA	2
Mb,c C8	68	Planoepithelial carcinoma right lung (complete resection and chemo)	Thoracic region (scar)	0.5		1	6	Shooting	Y	1	0.5	2
Fb C2	70	Liposarcoma of left kidney	Left psoas + T12 nerve root	1	X	2	3–4	Dysesthesia	N	2	16	3
M C21	42	Pulmonary cancer-persistent pain Postthoracotomy	Right side of chest, radiation to scapula	1	X	2	4	Shooting	N	1	2	3
Fa C26	44	Occipital sarcoma, epidural metastasis, L3 L4 L5 metastases	L3 radicular pain	0.06			6		N	3	NA	3
Fa C20	67	Persistent postmastectomy pain	Chest wall, right side	4		2	8	Burning, shooting	N	1	3	4

Notes:

a Pain also related to radiotherapy;

b pain also related to cancer;

c pain also related to chemotherapy. Allodynia severity rating: 0 = no pain or discomfort to touch, 1 = uncomfortable, but tolerable to touch, 2 = painful, 3 = extremely painful, patient cannot stand touching; duration of pain was converted to years.

Abbreviations: CGIC, Clinical Global Impression of Change rating during treatment with 5% lidocaine-medicated plaster: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change; F, female; M, male; NA, not available; N, no; X, symptom present; Y, yes.

Figure 2 Twenty-four case reports of patients with trigeminal neuropathic pain were available for review.

Abbreviation: CGIC, Clinical Global Impression of Change.

Table 5 Case reports for trigeminal pain

Gender /case number	Age	Primary diagnosis (pain indication/cause of pain/type of pain)	Localization of pain symptoms/predominantly intra-or extraoral	Duration of pain in years	Hyper-algesia	Allodynia/allodynia severity rating	Pain intensity (0–10)	Characteristics of pain	Mono-therapy	Plasters per day	Duration of plaster treatment (months)	CGIC score
Trigeminal neuralgia
M T4	76	Trigeminal neuralgia Intermittent pain	Left V1 Extraoral	0.19	X	2	9	Stabbing	N	1/8	1.17	1
Ma T26	82	Trigeminal neuralgia type 2 Continuous pain	Right V1,2,3 Extraoral	20	X	3	8–10	Burning	N	1/2	0.93	1
M T27	53	Trigeminal neuralgia Intermittent pain	Right V Extraoral	3	X	2	5	Stabbing	Y	1/2	0.93	1
F T2	62	Trigeminal neuralgia type 2 Continuous pain with intermittent flares	Left Extraoral	3			7	Burning, shooting	N	1/2	NA	2
F T6	29	Trigeminal neuralgia Intermittent pain	V2 Extraoral	0.5	X	1	7	Shooting	N	1/2	0.75	2
Ma T24	35	Trigeminal neuralgia Intermittent pain	Left V2 Extraoral	3		2	8	Shooting	N	1/4	3	2
F T18	62	Trigeminal neuralgia type 2 Continuous pain with intermittent flares	Right V2,3 Extraoral, mainly intraoral	14		2	8	Stabbing, shooting, aching	N	1/2	0.25	4
M T1	75	Trigeminal neuralgia Intermittent pain	Left V2,3 Extraoral	5			8	Stabbing, shooting	N	1/2	2	4
M T3	80	Trigeminal neuralgia Intermittent pain	Left V2,3	≥5		1	9	Stabbing, shooting	Y	1/2, not daily	<0.03	5
F T23	82	Neuralgia SUNCT Continuous pain with intermittent flares	Left V1,2,3 Extraoral	5		1	7	Burning, sharp, aching, dull	N	1	1	4
Trigeminal neuropathic pain following surgery for trigeminal neuralgia
F T17	53	Neuropathic pain Continuous pain	Right V2,3 Intra- and extraoral	12		2	10	Shooting, sharp	Y	1/2	9	1
F T21	49	Neuropathic pain Continuous pain	Right V2,3 Extraoral	2		2	8	Burning	N	1 weekly	1	3
F T11	64	Bilateral neuropathic pain Intermittent pain	Right V2,3 Extraoral	3		1	8	Shooting, hot, pricking	N	1/2	0.17	3, sleep improved
Fa T7	35	Neuropathic pain Continuous pain with intermittent flares	V2,3 Extraoral	2		2	8	Burning, shooting	N	1/2	0.7	3
F T12	72	Dysesthesia Continuous pain with intermittent flares	Left V3 Extraoral	7		2	8	Heavy, gripping	N	1/2	0.25	4
M T16	75	Dysesthesia Continuous pain	Left V2,3 Extraoral	25		1	8	Burning, soreness, nagging, numbness	Y	1	3	4
Trigeminal neuropathic pain following trauma
F T13	50	Trigeminal posttraumatic neuropathic pain Continuous pain	Left V2 Extraoral	1.5		2	9	Burning, tingling, pricking	N	1/2	4	2
F T22	65	Trigeminal neuropathic pain Continuous pain with intermittent flares	Left V1,2,3 Extraoral	3		1	8	Burning, shooting, throbbing, drilling, heavy, piercing	N	1 every 2nd day	7	2 sleeps better
F T15	63	Neuropathic pain after extractions Continuous pain with intermittent flares	Right V3 Intraoral Extraoral	3			7	Shooting, cutting, aching, throbbing	N	1/2	3	2
M T20	44	Trigeminal neuropathic pain after dental extractions Continuous pain with intermittent flares	Right V1,2,3 Extraoral	4		1		Burning, sharp, dull	N	1 every 2nd day	0.5	4
Trigeminal neuropathic pain following postherpetic neuralgia
F T10	45	Postherpetic neuralgia Continuous pain with intermittent flares	Right V1 Extraoral	2.5		1	10	Stabbing, searing, burning, shooting, dull	N	1/2	3	2
M T8	78	Postherpetic neuralgia Continuous pain with intermittent flares	Right V1 Extraoral	0.25		2	7	Burning	N	1/4	3	2
F T14	74	Postherpetic neuralgia Continuous pain	Left V1 Extraoral	1.67			4	Burning, itchy, hot, numb, tingling	Y	Intermittent	4	2
F T19	76	Postherpetic neuralgia pain and burning mouth syndrome Continuous pain with intermittent flares	Right V2 Intra- and extraoral	2		1	9	Burning, drilling	N	1/2	Few weeks	3

Notes: Pain was initiated by triggers if not otherwise stated.

a no triggers. Allodynia severity rating: 0 = no pain or discomfort to touch, 1 = uncomfortable, but tolerable to touch, 2 = painful, 3 = extremely painful, patient cannot stand touching; duration of pain was converted to years, term “many years” was set to ≥5 years in the table and to 5 years for calculation of means.

Abbreviations: CGIC, Clinical Global Impression of Change rating during treatment with 5% lidocaine-medicated plaster: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change, 5 = minimally worse; F, female; M, male; NA, not available; N, no; SUNCT, short unilateral neuralgiform pain with conjunctival tearing; V1, ophthalmic; V2, maxillary; V3, mandibular; X, symptom present; Y, yes.

Table 6 Probability of treatment success with 5% lidocaine-medicated plaster

Probability	Potential predictors	Indication
		Long-terma	Short-termb
High	Localized pain	Postherpetic neuralgia	Post herpes zoster
	Superficial pain	Diabetic polyneuropathy	Scar pain (postsurgery)
	Allodynia	Chronic postsurgical pain
		Complex regional pain syndrome
Medium	Hyperalgesia	Low back pain (chronic)	Low back pain
	Burning	Cancer pain with neuropathic components	Carpal tunnel syndrome
	Stabbing	Trigeminal neuropathic pain
	Shooting
	Numeric rating scale score
Low	Deep pain	Central pain	Fibromyalgia
	Numbness		Arthrosis
	Radiating pain		Gout
	Radicular pain		Phantom limb pain
	Heavy sweating		Muscular pain
	Pain site distant from nerve damage
	Chronic widespread

Notes:

a Duration months to years;

b duration days to weeks.