Treatment of Painful Stump with Lidocaine Patches

María Vázquez Guimaraens

MD specialist in Physical Medicine and Rehabilitation and PhD in Neuroscience, Servizo Galego de Saúde (SERGAS), Spain

María Vázquez Guimaraens, MD specialist in Physical Medicine and Rehabilitation and PhD in Neuroscience, Servizo Galego de Saúde (SERGAS), Spain.

Keywords: Lidocaine; Stump Pain; Phantom Limb Pain; Scar Hyperalgesia; Rehabilitation

Abstract

Phantom limb pain and scar hyperalgesia are recurrent problems after amputation. The neuropathic nature suggests the involvement of both peripheral and central neurological mechanisms, involving neuroplastic changes in the central nervous system and scar hyperalgesia is correlated with secondary mechanical hyperalgesia in the skin area around the scar.
The patient usually presents dysesthesia, pain in burning, stabbing, electric shock, or just itching making very difficult his recovery and rehabilitation.
Neuropathic pain has a negative impact on quality of life of the amputees and it required a specific pharmacologic therapy.
The lidocaine patch 5% is a topical analgesic, non-invasive and with minimal systemic absorption.
Treating scar hyperalgesia or phantom limb pain on the stump with topical lidocaine may reduce the activity of peripheral nociceptive afferents and thus decrease the likelihood of developing persistent phantom limb pain.
The aim of the present research is to investigate if a lidocaine patch 5% is effective for reducing phantom limb pain and primary or secondary scar hyperalgesia.
After the first adhesive dressing used all reported a pain relief between 70-80% and following one month of treatment, an improvement in walking pain and walking patterns was obtained. The patients indicated that the lidocaine patch provided mechanical protection for the scar; at this time, it was decided to discontinue treatment with opioids progressively. At 3 months, patients were treated with 5% lidocaine patches as the only treatment and reported a 100% improvement in pain and the physical examination showed no hyperalgesia, no allodynia and they quality of life were increase.
None of the patients in the case series suffered any local or systemic adverse reactions to lidocaine plaster use and the patients’ adherence to treatment was excellent in all cases.
Lidocaine patch was shown to be a safe, efficient treatment for localised post-traumatic or postsurgical neuropathic pain; our results also suggest that significantly improves patients’ functional level, and is associated with an improvement in occupational performance.

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