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Skin biopsy and quantitative sensory testing do not predict response to lidocaine patch in painful neuropathies.
Muscle Nerve. 2006 Jan; 33(1):42-8.MN

Abstract

Predictors of response to neuropathic pain treatment in patients with painful distal sensory neuropathies are lacking. The 5% lidocaine patch is believed to exert its effects on neuropathic pain via a local stabilizing effect on cutaneous sensory afferents. As such, it provides a model to assess whether the status of epidermal innervation as determined by skin biopsy or quantitative sensory testing (QST) of small- and large-diameter sensory afferents might serve as predictors of response to topical, locally active treatment. In this study we assessed associations between epidermal nerve fiber (ENF) densities, sensory nerve conduction studies (NCS), QST, and response to a 5% lidocaine patch in patients with painful distal sensory neuropathies. We observed no association between distal leg epidermal and subepidermal innervation and response to the lidocaine patch. Several patients with complete loss of distal leg ENF showed a response to the lidocaine patch. Similarly we observed no consistent association between treatment response and QST for vibration, cooling, warm, heat-pain, and cold-pain thresholds, or distal sensory NCS. Thus, distal-leg skin biopsy, QST, and sensory NCS cannot be used to identify patients with painful polyneuropathy likely to respond to a lidocaine patch in clinical practice. Further studies are required to clarify precisely the mechanism and site of action of the lidocaine patch in patients with peripheral neuropathic pain.

Authors+Show Affiliations

Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY 14642, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16228968

Citation

Herrmann, David N., et al. "Skin Biopsy and Quantitative Sensory Testing Do Not Predict Response to Lidocaine Patch in Painful Neuropathies." Muscle & Nerve, vol. 33, no. 1, 2006, pp. 42-8.
Herrmann DN, Pannoni V, Barbano RL, et al. Skin biopsy and quantitative sensory testing do not predict response to lidocaine patch in painful neuropathies. Muscle Nerve. 2006;33(1):42-8.
Herrmann, D. N., Pannoni, V., Barbano, R. L., Pennella-Vaughan, J., & Dworkin, R. H. (2006). Skin biopsy and quantitative sensory testing do not predict response to lidocaine patch in painful neuropathies. Muscle & Nerve, 33(1), 42-8.
Herrmann DN, et al. Skin Biopsy and Quantitative Sensory Testing Do Not Predict Response to Lidocaine Patch in Painful Neuropathies. Muscle Nerve. 2006;33(1):42-8. PubMed PMID: 16228968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skin biopsy and quantitative sensory testing do not predict response to lidocaine patch in painful neuropathies. AU - Herrmann,David N, AU - Pannoni,Valerie, AU - Barbano,Richard L, AU - Pennella-Vaughan,Janet, AU - Dworkin,Robert H, PY - 2005/10/18/pubmed PY - 2006/3/18/medline PY - 2005/10/18/entrez SP - 42 EP - 8 JF - Muscle & nerve JO - Muscle Nerve VL - 33 IS - 1 N2 - Predictors of response to neuropathic pain treatment in patients with painful distal sensory neuropathies are lacking. The 5% lidocaine patch is believed to exert its effects on neuropathic pain via a local stabilizing effect on cutaneous sensory afferents. As such, it provides a model to assess whether the status of epidermal innervation as determined by skin biopsy or quantitative sensory testing (QST) of small- and large-diameter sensory afferents might serve as predictors of response to topical, locally active treatment. In this study we assessed associations between epidermal nerve fiber (ENF) densities, sensory nerve conduction studies (NCS), QST, and response to a 5% lidocaine patch in patients with painful distal sensory neuropathies. We observed no association between distal leg epidermal and subepidermal innervation and response to the lidocaine patch. Several patients with complete loss of distal leg ENF showed a response to the lidocaine patch. Similarly we observed no consistent association between treatment response and QST for vibration, cooling, warm, heat-pain, and cold-pain thresholds, or distal sensory NCS. Thus, distal-leg skin biopsy, QST, and sensory NCS cannot be used to identify patients with painful polyneuropathy likely to respond to a lidocaine patch in clinical practice. Further studies are required to clarify precisely the mechanism and site of action of the lidocaine patch in patients with peripheral neuropathic pain. SN - 0148-639X UR - https://www.unboundmedicine.com/medline/citation/16228968/Skin_biopsy_and_quantitative_sensory_testing_do_not_predict_response_to_lidocaine_patch_in_painful_neuropathies_ L2 - https://doi.org/10.1002/mus.20419 DB - PRIME DP - Unbound Medicine ER -