3073 Review of the effectiveness of transdermal lidocaine for osteoarthritic pain

Abstract Introduction About 73% of people living with osteoarthritis are older than 55 years. Osteoarthritis can greatly reduce the quality of life. While surgical interventions (including joint replacement) present one approach to advanced and disabling osteoarthritis, non-surgical interventions help people living with the condition to manage pain and maintain optimal levels of functioning. Pharmacological options should be used in combination with non-pharmacological measures at the lowest effective dose for the shortest period of time possible. Lidocaine 5% plasters are used off licence in clinical practice to treat chronic pain, and pain from osteoarthritis. The lidocaine contained in the medicated plaster diffuses continuously into the skin, providing a local analgesic effect. The low systemic exposure to lidocaine following use of the lidocaine patch 5% is particularly beneficial for patients with polypharmacy, or for patients who have low tolerance for systemic analgesics. The aim of this review was to examine the current evidence for using transdermal lidocaine patch in managing pain from osteoarthritis. Method A comprehensive literature search was performed using electronic databases to identify studies that assessed the effectiveness of transdermal lidocaine in osteoarthritis. Reference lists of included studies were also reviewed. Results 6 studies were included in the review, with a total of 359 patients. 3 studies used the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and showed significant improvement from baseline with use of 5% lidocaine patch in WOMAC pain scores (p < 0.01), and 1 study showed significant improvement all 4 Neuropathic Pain Scale composite measures (p < 0.001). 3 studies were included in a meta-analysis. This showed a significant improvement across pain, stiffness and physical function on WOMAC Osteoarthritis Index. Conclusion Although these studies included small numbers, they have shown a positive effect. Geriatric patients are more likely to have co-morbidities, frailty and polypharmacy which would prevent surgical/systemic pharmacological interventions. Further trials in this area would be beneficial.