701: Evaluation of the Efficacy of Lidocaine 5% versus Capsaicin 0.075% patches in Postherpetic Neuralgia

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Pain Category (ICD-11), Chronic neuropathic pain, Pharmacological treatments, Assessment and Measurement of Pain/Nociception

Background and Aims: Background: Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that significantly affects quality of life. Topical analgesic patches such as lidocaine and capsaicin provide localized pain relief with minimal systemic effects; however, comparative evidence regarding their efficacy and patient-centered outcomes is limited.
Aim: To compare the efficacy, patient satisfaction, and side-effect profile of a 5% lidocaine patch versus a 0.075% capsaicin patch in patients with postherpetic neuralgia of the thoracolumbar dermatome.

Methods: This prospective, randomized pilot study was conducted on 20 patients of PHN, allocated to two groups of 10 each. Group L received 5% lidocaine patch and Group C received a 0.075% capsaicin patch, applied to the most tender area of affected dermatome, three patches consecutively over a three-day period, 12 hours patch on followed by 12 hours of patch-free duration. Pain intensity was assessed using Numeric Rating Scale (NRS) and Neuropathic Pain Symptom Inventory (NPSI) at baseline and through telephonic conversation at 12 hours, then everyday up to 7 days, patient satisfaction recorded on 5-point Likert scale. Adverse effects were recorded.

Results: Both treatment groups demonstrated a reduction in NRS and NPSI scores from baseline. The capsaicin 0.075% patch group showed a greater reduction in NRS and NPSI scores compared to the lidocaine 5% patch group. Patient satisfaction scores were also higher in this group, with a larger proportion reporting being “satisfied” or “very satisfied”. Though a higher incidence of local adverse effects were seen with Capsaicin, including burning sensation and erythema at the application site, these were transient, self-limiting, not necessitating treatment discontinuation. Lidocaine patch was well tolerated with minimal local side effects. No serious adverse events were observed in either group.

Conclusions: In this pilot study, the 0.075% capsaicin patch demonstrated superior analgesic efficacy and higher patient satisfaction compared to the 5% lidocaine patch in patients with postherpetic neuralgia, during the one-week study period. A higher incidence of local adverse effects was noted with capsaicin, which resolved spontaneously. Large multicentric randomized controlled studies are required to confirm these findings and guide clinical practice.

References: 1. Xu J, Zhang Y, Li H, et al. Randomized, placebo-controlled, multicenter clinical study on the efficacy and safety of lidocaine patches in Chinese patients with postherpetic neuralgia. Pain Res Manag. 2023;2023:1–8.
2. Derry S, Wiffen PJ, Moore RA. Topical capsaicin for neuropathic pain in adults. Cochrane Database Syst Rev. 2011;(2):CD007393.
3. Wang Y, Liu X, Chen L, et al. The treatment of topical drugs for postherpetic neuralgia. Chin J Clin Neurosci. 2020;28(4):412–416.
4. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Pain Res Manag. 2017;2017:1–9.

Presenting Author: Prof Hammad Usmani
Submitting Author: Hammad Usmani

Senior Author: Prof Hammad Usmani

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr Nazia Tauheed: MD, PDF - Department of Anaesthesiology, J.N. Medical College, Aligarh Muslim University (AMU), Aligarh
• Dr Mohammad Adil: MD Dermatology - Department of Dermatology, J.N. Medical College, Aligarh Muslim University (AMU)
• Dr Nazish Hussain: MBBS - Department of Anaesthesiology, J.N. Medical College, Aligarh Muslim University (AMU)