Inappropriate Use of Lidocaine Patches Cited

LAS VEGAS—Lidocaine patches are being widely used to treat certain types of pain for which they were not approved despite a lack of efficacy evidence, according James D. Ray, PharmD, Pharmacy Clinical Coordinator for Pain and Palliative Care at the University of Virginia Health System in Charlottesville.

Speaking at a session titled, "Topical and Transdermal Analgesics," Dr. Ray noted that the lidocaine patch is approved by the FDA for treating postherpetic neuralgia, but it has been used for other neuropathic pain conditions. “The simple fact of the matter is, we don't have any evidence to do that,” he said. “We need to rethink that. In my particular center, we have a lot of people using it postoperatively, applying it next to incisions and there's absolutely no good data to do that.” He said his center spent a half million dollars using lidocaine patches mostly for surgical incisional pain in the past 3 years.

Although lidocaine patches are well tolerated and has a low risk of toxicity, “we spend a lot of money for doing something that doesn't make much difference.”

Also during his presentation, he spoke about the potential usefulness of compounding topical analgesic creams. There is some evidence that analgesic drugs get absorbed through the skin and produce systemic effects, but “it's an area where we don't have a lot of good evidence.” More science is needed to ascertain how many drugs should be combined in a topical preparation and the best combination of drugs.