Garzon-Rodriguez, C., Casals Merchan, M., Calsina-Berna, A., Lopez-Romboli, E., & Porta-Sales, J. (2013). Lidocaine 5% patches as an effective short-term co-analgesic in cancer pain. Preliminary results. Supportive Care in Cancer, 21, 3153–3158.

To evaluate the short-term efficacy of lidocaine 5% patches for pain scars and pain caused by chest wall tumors

Patients seen in the palliative care outpatient clinic were included. They were instructed to apply up to a maximum of three patches at a time to cover the painful area for 12 hours each day. All patients had to have pain with a neuropathic component plus allodynia.

• N = 20
• MEAN AGE = 62 years
• MALES: 55%, FEMALES: 45%
• KEY DISEASE CHARACTERISTICS: 55% had lung cancer, 40% were receiving chemotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: All were on opioids, receiving a mean oral morphine equivalent daily dose of 125 mg per day. Seventy percent were on gabapentin or pregabalin, 45% were on corticosteroids, 5% were on antidepressants, and 45% were receiving two coanalgesics.

• SITE: Single site 
• SETTING TYPE: Outpatient 
• LOCATION: Spain

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Palliative care

• Open-label, prospective, observational

• Numeric pain scale

Mean duration of treatment was 29.2 days (range 3–90).  Five patients discontinued in less than 10 days because of lack of efficacy. At the end of follow-up, pain scores declined by an average of two points (p < .05). Rating of breakthrough pain level declined significantly (p < .05).

Findings suggest that lidocaine patches might be helpful for some patients with pain from scarring and chest wall tumors, but the study had multiple limitations and findings lack strong support for the intervention.

• Small sample (less than 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Subject withdrawals of 10% or more
• Other limitations/explanation: Timing of follow-up measures is not stated or described, and what specific measures of pain or breakthrough pain are used is not clear (e.g., worst, average, daily, overall). Information on whether other changes in medications occurred during the same period is not provided. In the discussion, the authors state that opioid titration during the study was allowed, suggesting that ongoing medication adjustment also likely contributed to results.

Lidocaine patches might be of some help for patients with certain types of pain that are well localized and superficial. Although findings of this study were somewhat positive, the evidence is weak and this report has numerous limitations. Further well-designed, larger studies need to be done.