Efficacy of the Versatis- lignocaine patch in patients with non-postherpetic neuropathic pain

Background
The use of the 5% lignocaine medicated patch, Versatis®, is restricted to treatment of postherpetic neuralgia in NHS Scotland. Potentially patients with other causes of neuropathic pain may benefit from Versatis®. We aimed to review the efficacy of Versatis® in patients, with non-postherpetic neuropathic pain, attending the chronic pain service at our institution.
Methods
From February to September 2010, patients with symptoms of neuropathic pain, amenable to topical therapy, were treated with Versatis®. At their baseline visit, each patient completed a Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire and a Brief Pain Inventory (BPI). Only scores examining the effect of pain on activities of daily living (general activity, mood, walking ability, normal work, relations with others, sleep and enjoyment of life) were recorded. At 4 month follow-up, patients repeated the BPI. Patient Global Impression of Change (PGIC) and percentage pain relief were also recorded.
Results
Results of 10 patients of mean(± SD) age 64.7(±11.6) years were analysed. Median(range) S-LANSS score was 14(2-18). At 4 months follow-up, the most frequent PGIC chosen was “no change”. Median(range) percentage pain relief obtained was 10(0-80)%. Although the median(range) total BPI scores examining the effect of pain on activities of daily living fell from 48(37-63) at baseline to 41(10-54) at 4 months this was not statistically significant (p=0.13). Three patients did benefit from their patch with median(range) total BPI scores reduced from 50(46-50) to 33(12-54), pain relief of 60%,70% and 80% respectively and PGIC choice of “much improved” or “very much improved”. Two of these patients had ongoing use of the patch at 4 months. The other patient discontinued the patch after 6 weeks because it had desensitised the neuropathic pain in her foot so much, that weight bearing was now possible. Two
patients developed erythema, pruritis and vesicles from the patch.
Conclusion
The use of Versatis® in our group of patients with non-postherpetic neuropathic pain showed no statistical benefit in analgesia or the effect of pain on activities of daily living. Versatis® could be trialled for patients with neuropathic pain that is non-postherpetic in origin and a 30% success rate expected.