• Richard L Barbano, David N Herrmann, Stephanie Hart-Gouleau, Janet Pennella-Vaughan, Peter A Lodewick, and Robert H Dworkin.
• Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Richard_Barbano@URMC.Rochester.edu
• Arch Neurol Chicago. 2004 Jun 1;61(6):914-8.

BackgroundThe treatment of painful diabetic polyneuropathy (DPN) is often inadequate and frequently limited by the systemic adverse effects of medications, necessitating the evaluation of novel treatments.ObjectiveTo evaluate the effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in painful diabetic polyneuropathy.DesignOpen-label, flexible-dosing, 3-week study with a 5-week extension.SettingOutpatient clinics and clinical research centers.Patients Volunteer sample of 56 patients with clinically defined painful diabetic polyneuropathy of longer than 3 months' duration. Intervention The 5% lidocaine patch, with a maximum of 4 patches daily for 18 hours.Main Outcome MeasuresChange in mean daily pain diary ratings from baseline to week 3. Secondary end points included assessments of safety, tolerability, and quality of life.ResultsPatients with painful diabetic polyneuropathy showed significant improvements in pain and quality-of-life outcome measures during a 3-week treatment period. These benefits were maintained in a subgroup of patients treated for an additional 5 weeks, during which taper of concomitant analgesic therapy was permitted. Adverse events were minimal, and systemic accumulation of lidocaine did not occur.ConclusionsUp to four 5% lidocaine patches for up to 18 h/d are well tolerated in patients with painful diabetic polyneuropathy, significantly improve pain and quality-of-life ratings, and may allow tapering of concomitant analgesic therapy. Given the open-label design of this trial, a randomized controlled trial is necessary to confirm these results.

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