• Claudia Sommer and Giorgio Cruccu.
• Neurologische Klinik, Universitätsklinikum Würzburg, Würzburg, Germany. Electronic address: sommer@uni-wuerzburg.de.
• J Pain Symptom Manage. 2017 Mar 1; 53 (3): 614-629.

ContextPatients with peripheral neuropathic pain (NP) may only achieve partial pain relief with currently recommended first-line oral treatments, which are also associated with systemic adverse events. Topical treatments are currently considered second- or third-line options, but a recent pharmacologic treatment algorithm has called for broader first-line use of these agents. This has highlighted a need to communicate the benefits associated with topical agents, in particular around the efficacy, targeted local action, and limited systemic availability resulting in minimal systemic adverse events and drug-drug interactions.ObjectivesThis review aims to evaluate the evidence base for topical therapies currently used to treat peripheral NP, discuss the evidence comparing these treatments head-to-head with oral standard of care, and evaluate how they fit into treatment regimens in the "real world."MethodsThis is a narrative review.ResultsTwo topical treatments are currently licensed: lidocaine 5% medicated plaster (post-herpetic neuralgia) and the capsaicin 8% patch (peripheral NP). When compared head to head with the oral standard of care (pregabalin), the lidocaine 5% medicated plaster provided similar relief of pain associated with post-herpetic neuralgia but did not meet the primary predefined criteria for noninferiority. The capsaicin 8% patch, however, demonstrated noninferior efficacy when compared head-to-head with pregabalin across a wide range of peripheral NP etiologies. Importantly, both treatments demonstrated effective pain relief without the systemic adverse events associated with oral therapies.ConclusionFirst-line use of topical agents may be of particular benefit in patients where the safety and tolerability of oral therapy is a concern.Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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