Topical lidocaine patch 5% may target a novel underlying pain mechanism in osteoarthritis
Topical lidocaine patch 5% may target a novel underlying pain mechanism in osteoarthritis
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DOI：
10.1185/030079904x2754
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发表时间：
2004-09-01
影响因子：
2.3
通讯作者：
Garnmaitoni, AR
中科院分区：
文献类型：
--
作者：
Galer, BS;Sheldon, E;Garnmaitoni, AR
最近的文献和动物研究为治疗骨关节炎（OA）疼痛提供了潜在的新镇痛靶点。位于受影响关节的初级传入神经元在其表面上表达过量的功能异常的钠（Na）通道以响应炎症过程。这些Na通道可能在疼痛和痛觉过敏的产生中起着不可或缺的作用。因此，作者开始进行一项为期2周、开放标签、多中心概念验证研究，以评价5%利多卡因贴剂单药治疗膝关节OA疼痛成人患者的有效性和安全性（n = 20）。入组单膝或双膝OA患者，这些患者使用当前镇痛方案（即APAP、NSAID、考克斯-2抑制剂、曲马多）时疼痛缓解不足（定义为0 - 10疼痛量表上平均每日疼痛强度> 4），并停用所有镇痛药物。使用5%利多卡因贴剂治疗后，西安大略和麦克马斯特大学OA指数（WOMAC）疼痛、僵硬、身体功能子量表和综合指数显著改善（分别改善48.4%、41.1%、47.0%和46.8%，p < 0.01）。此外，疼痛强度、疼痛缓解和疼痛干扰与生活质量的显著改善（通过简明疼痛量表测量）（p < 0.05）。5%利多卡因贴剂通常耐受良好，没有患者因治疗相关不良事件而停药。鉴于开放标签设计，缺乏对照组，样本量小，我们的初步研究结果需要通过更大的随机对照试验来证实。局部使用5%利多卡因贴剂可能为临床医生提供一种具有独特作用机制的新型非全身性OA疼痛治疗方法。
Recent literature and animal research has provided insight to potentially new analgesic targets for managing osteoarthritis (OA) pain. Primary afferent neurons located in affected joints express excessive amounts of abnormally functioning sodium (Na) channels on their surface in response to the inflammatory process. These Na channels may play an integral role in production of pain and hyperalgesia. Hence, the authors set out to conduct a 2-week, open-label, multicenter proof-of-concept study to evaluate the effectiveness and safety of lidocaine patch 5% monotherapy in adults with OA pain of the knee (n = 20). Patients with OA of one or both knees who were experiencing inadequate pain relief (defined as an average daily pain intensity of > 4 on a 0 to 10 pain scale) with their current analgesic regimen (i.e. APAP, NSAIDs, COX-2 inhibitors, tramadol) were enrolled and had all analgesic medications discontinued. Treatment with the lidocaine patch 5% resulted in significant improvements in the Western Ontario and McMaster Universities OA Index (WOMAC) pain, stiffness, physical function subscales and composite index (48.4, 41.1, 47.0, and 46.8% improvements respectively, p < 0.01). In addition, significant improvement was noted for pain intensity, pain relief, and pain interference with quality of life as measured by the Brief Pain Inventory (p < 0.05). The lidocaine patch 5% was generally well tolerated and no patients discontinued due to treatment-related adverse events. Given the open-label design, lack of a control group, and small sample size, the findings from our pilot study need to be confirmed by larger randomized controlled trials. Topical lidocaine patch 5% may provide clinicians with a novel, non-systemic therapy for OA pain with a unique mechanism of action.