OBJECTIVES

Neuropathic pain prevalence is approximately 7%-10%. International guidelines recommend a variety of drugs for pain relief. However, side effect profiles prompted the UK government recently to classify pregabalin and gabapentin as class C drugs. 700 mg lidocaine medicated plaster (LMP) might be safer. A systematic review assessed how LMP and pregabalin (300/600mg) compared in terms of efficacy and safety. The review assessed pain reduction (Numerical Rating Scale (NRS)), quality of life and adverse events in peripheral neuropathic pain (PNP) i.e. post-herpetic neuralgia, diabetic peripheral neuropathy (DPN), post-surgical/trauma, or other PNP conditions.

METHODS :

Sensitive strategies were used, unrestricted by language or publication status. Two independent reviewers screened records and extracted data with consensus as required. Risk of bias was assessed using the Cochrane Collaboration 2011 checklist for randomised controlled trials (RCTs) and a full Bayesian network meta-analysis was conducted.

RESULTS

Searches retrieved 7,104 records. Data were extracted from 43 RCTs, all but one double blind. Meta-analyses showed similar reduction in NRS between LMP and pregabalin (300/600mg). However, LMP reduced adverse events versus pregabalin 600mg and 300mg including dizziness (relative risk (95%CI); 0.03 (0.001, 0.81) versus 600mg; 0.04 (0.001, 1.03) versus 300mg) and discontinuations (relative risk (95%CI); 0.23 (0.06, 0.90) versus 600mg; 0.20 (0.04, 0.92) versus 300mg). It also improved quality of life albeit only from one RCT versus pregabalin 600mg in DPN (mean difference (95%CI) 0.07 (0.005, 0.13), not available for 300mg).

CONCLUSIONS

LMP was found to be similar to pregabalin in reducing pain in all populations but had a better adverse events profile. These findings support the recommendation of LMP for any PNP as a safe alternative to pregabalin.