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Lidocaine patch (5%) is no more potent than placebo in treating chronic back pain when tested in a randomised double blind placebo controlled brain imaging study.

Hashmi JA, Baliki MN, Huang L, Parks EL, Chanda ML, Schnitzer T, Apkarian AV - Mol Pain (2012)

Bottom Line: However, 50% patients in both the Lidocaine and placebo arms reported a greater than 50% decrease in pain suggesting a marked placebo effect.When tested against an untreated CBP group at similar time points, the patch treated subjects showed significantly greater decrease in pain compared to the untreated group (n = 15).These findings suggest that although the 5% Lidocaine is not better than placebo in its effectiveness for treating pain, the patch itself induces a potent placebo effect in a significant proportion of CBP patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.

ABSTRACT

Background: The 5% Lidocaine patch is used for treating chronic neuropathic pain conditions such as chronic back pain (CBP), diabetic neuropathy and complex regional pain syndrome, but is effective in a variable proportion of patients. Our lab has reported that this treatment reduces CBP intensity and associated brain activations when tested in an open labelled preliminary study. Notably, effectiveness of the 5% Lidocaine patch has not been tested against placebo for treating CBP. In this study, effectiveness of the 5% Lidocaine patch was compared with placebo in 30 CBP patients in a randomised double-blind study where 15 patients received 5% Lidocaine patches and the remaining patients received placebo patches. Functional MRI was used to identify brain activity for fluctuations of spontaneous pain, at baseline and at two time points after start of treatment (6 hours and 2 weeks).

Results: There was no significant difference between the treatment groups in either pain intensity, sensory and affective qualities of pain or in pain related brain activation at any time point. However, 50% patients in both the Lidocaine and placebo arms reported a greater than 50% decrease in pain suggesting a marked placebo effect. When tested against an untreated CBP group at similar time points, the patch treated subjects showed significantly greater decrease in pain compared to the untreated group (n = 15).

Conclusions: These findings suggest that although the 5% Lidocaine is not better than placebo in its effectiveness for treating pain, the patch itself induces a potent placebo effect in a significant proportion of CBP patients.

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Related in: MedlinePlus

Pain did not differ between chronic back pain (CBP) patients treated with 5% lidocaine patches or with patches containing no active drug (placebo). A. Variation of CBP pain with treatment type and treatment duration. Treatment duration, but not type, significantly decreased CBP pain. B-E. Effect of treatment type and duration on sensory (range 0-33) and affective scores (range 0-12) obtained on the McGill pain Questionnaire (MPQ). Sensory and affective scores decreased with treatment duration for both types of treatment. Error bars represent SEMs. * p ≪ 0.05, ** p ≪ 0.01 differences from baseline.
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Figure 1: Pain did not differ between chronic back pain (CBP) patients treated with 5% lidocaine patches or with patches containing no active drug (placebo). A. Variation of CBP pain with treatment type and treatment duration. Treatment duration, but not type, significantly decreased CBP pain. B-E. Effect of treatment type and duration on sensory (range 0-33) and affective scores (range 0-12) obtained on the McGill pain Questionnaire (MPQ). Sensory and affective scores decreased with treatment duration for both types of treatment. Error bars represent SEMs. * p ≪ 0.05, ** p ≪ 0.01 differences from baseline.

Mentions: There was a significant decrease in back pain magnitude with treatment duration (F 2,89 = 7.8, p ≪ 0.001) but no treatment type effect (F1,89 = 0.72, p = 0.4), and no significant interaction between type and duration of treatment (F 2,89 = 0.03, p = 0.99). At baseline, the lidocaine treated group did not show a significant difference in back pain magnitude from the placebo group (Figure 1A). Similarly, there was no treatment type effects at the 6 hour (F 1,29 = 0.18, p = 0.89) and 2 week period (F 1,29 = 1.06, p = 0.31).


Lidocaine patch (5%) is no more potent than placebo in treating chronic back pain when tested in a randomised double blind placebo controlled brain imaging study.

Hashmi JA, Baliki MN, Huang L, Parks EL, Chanda ML, Schnitzer T, Apkarian AV - Mol Pain (2012)

Pain did not differ between chronic back pain (CBP) patients treated with 5% lidocaine patches or with patches containing no active drug (placebo). A. Variation of CBP pain with treatment type and treatment duration. Treatment duration, but not type, significantly decreased CBP pain. B-E. Effect of treatment type and duration on sensory (range 0-33) and affective scores (range 0-12) obtained on the McGill pain Questionnaire (MPQ). Sensory and affective scores decreased with treatment duration for both types of treatment. Error bars represent SEMs. * p ≪ 0.05, ** p ≪ 0.01 differences from baseline.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475108&req=5

Figure 1: Pain did not differ between chronic back pain (CBP) patients treated with 5% lidocaine patches or with patches containing no active drug (placebo). A. Variation of CBP pain with treatment type and treatment duration. Treatment duration, but not type, significantly decreased CBP pain. B-E. Effect of treatment type and duration on sensory (range 0-33) and affective scores (range 0-12) obtained on the McGill pain Questionnaire (MPQ). Sensory and affective scores decreased with treatment duration for both types of treatment. Error bars represent SEMs. * p ≪ 0.05, ** p ≪ 0.01 differences from baseline.
Mentions: There was a significant decrease in back pain magnitude with treatment duration (F 2,89 = 7.8, p ≪ 0.001) but no treatment type effect (F1,89 = 0.72, p = 0.4), and no significant interaction between type and duration of treatment (F 2,89 = 0.03, p = 0.99). At baseline, the lidocaine treated group did not show a significant difference in back pain magnitude from the placebo group (Figure 1A). Similarly, there was no treatment type effects at the 6 hour (F 1,29 = 0.18, p = 0.89) and 2 week period (F 1,29 = 1.06, p = 0.31).

Bottom Line: However, 50% patients in both the Lidocaine and placebo arms reported a greater than 50% decrease in pain suggesting a marked placebo effect.When tested against an untreated CBP group at similar time points, the patch treated subjects showed significantly greater decrease in pain compared to the untreated group (n = 15).These findings suggest that although the 5% Lidocaine is not better than placebo in its effectiveness for treating pain, the patch itself induces a potent placebo effect in a significant proportion of CBP patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.

ABSTRACT

Background: The 5% Lidocaine patch is used for treating chronic neuropathic pain conditions such as chronic back pain (CBP), diabetic neuropathy and complex regional pain syndrome, but is effective in a variable proportion of patients. Our lab has reported that this treatment reduces CBP intensity and associated brain activations when tested in an open labelled preliminary study. Notably, effectiveness of the 5% Lidocaine patch has not been tested against placebo for treating CBP. In this study, effectiveness of the 5% Lidocaine patch was compared with placebo in 30 CBP patients in a randomised double-blind study where 15 patients received 5% Lidocaine patches and the remaining patients received placebo patches. Functional MRI was used to identify brain activity for fluctuations of spontaneous pain, at baseline and at two time points after start of treatment (6 hours and 2 weeks).

Results: There was no significant difference between the treatment groups in either pain intensity, sensory and affective qualities of pain or in pain related brain activation at any time point. However, 50% patients in both the Lidocaine and placebo arms reported a greater than 50% decrease in pain suggesting a marked placebo effect. When tested against an untreated CBP group at similar time points, the patch treated subjects showed significantly greater decrease in pain compared to the untreated group (n = 15).

Conclusions: These findings suggest that although the 5% Lidocaine is not better than placebo in its effectiveness for treating pain, the patch itself induces a potent placebo effect in a significant proportion of CBP patients.

Show MeSH
Related in: MedlinePlus