Survey on the Utilization of In-Hospital Formulation 10% Lidocaine Gel for Neuropathic Pain / 医薬品情報学

Objective: In many medical institutions in Japan, 10% lidocaine gel is prepared as an in-hospital formulation to treat intractable neuropathic pain. Clinical studies have reported the short-term efficacy of topical lidocaine therapy for neuropathic pain, while there are few reports in real-world practice. To clarify the clinical usage and its usefulness, in this study, we investigated the duration of use, amount, effectiveness, and safety of 10% lidocaine gel.Design: We conducted a retrospective study investigating the actual usage of 10% lidocaine gel using electronic medical records.Methods: This study included 74 patients treated with 10% lidocaine gel in Kyoto University Hospital between July 2019 and January 2022. Information about disease (purpose of use), concomitant medications and other background information of the patients were collected. In addition, the duration of use, amount, adverse events, and discontinuation of 10% lidocaine gel were investigated. Effectiveness was determined by physician interviews and the pain visual analogue scale (VAS).Results: Ten percent lidocaine gel was used primarily to treat postherpetic neuralgia and, in some cases, other types of chronic pain for a median duration of use of 3.2 months (0.03-118.5). Pain relief was achieved in 73.3% of patients according to physician interviews, with a significant decrease in the VAS score. Although adverse events were observed in 12 patients (16.2%), including skin problems (12.2%), paralysis (4.1%), and somnolence (1.4%), eight patients continued to use 10% lidocaine gel after their occurrence. Three patients discontinued it due to adverse events, and their symptoms subsequently improved thereafter.Conclusion: The present results suggest that 10% lidocaine gel is effective and safe even when used for a long-time. Although this is a single-center study, it is the first systematic investigation of real-world usage of an in-hospital formulation of 10% lidocaine gel and is expected to assist clinical practice and drug development.

Successfully Treated Venipuncture Pain with Jidabokuippou / 日本東洋医学雑誌

Venipuncture pain is rare complication. The underlying pathophysiology of venipuncture pain is incompletely solved and there is no standard treatment. Though most venipuncture pain is accepted as neuropathic pain, some venipuncture pain does not meet neuropathic pain criteria. Case 1 was a woman punctured dorsal vein for blood sampling. She visited pain clinic 9 days after injury because of residual pain and numbness. Case 2 was a woman punctured dorsal vein for intravenous line and radial artery for artery line at the time of operation. She visited pain clinic 16 days after injury because of residual pain. Case 3 was a woman punctured median cutaneous vein for blood sampling. She visited pain clinic 6 days after injury because of residual pain. We thought internal hemorrhage, local pain and tenderness as static blood and prescribed jidabokuippou for all 3 patients. All their pain improved. This report describes 3 cases of venipuncture pain successfully treated with jidabokuippou that shows the excellent analgesic action to nociceptive pain.

Successfully Treated Cluster Headache with Juzentaihoto / 日本東洋医学雑誌

This report describes a case of cluster headaches that was successfully treated with juzentaihoto. A 39-year-old male had been having attacks of cluster headaches for 7 years. During an attack, he took a triptan and nonsteroid anti-inflammatory drug (NSAID), but they were not effective and he had lost his good eyesight after the attack. Recently, as the attacks had become more frequently and stronger, he visited our hospital. Physical examination including dry skin suggested that he had kikyo and kekkyo. Therefore, we prescribed juzentaihoto. After 3 months of treatment, the frequency and strength of the attacks decreased. The underlying pathophysiology of cluster headaches incompletely solved. When the responsible localization of organic disease is not clear, Western medicine sometimes have difficulty in relieving pain. On the other hand, we can analyze the case through “yin-yang and xu-shi categorization,” “life force, blood and colorless bodily fluids (3 elements that constitute an organism)” and Gozo-roppu-setsu according to traditional Chinese medicine. Understanding the bodily functions from an Oriental medicine viewpoint, we can prescribe effective oriental medicine to relieve pain.