5% lidocaine-medicated plaster vs other relevant interventions and placebo for post-herpetic neuralgia (PHN): a systematic review.

Several pharmacological treatments are used to manage post-herpetic neuralgia (PHN). The use of topical analgesics, such as 5% lidocaine-medicated plaster (5% LMP), may be preferable to systemic treatments in that they are formulated to produce a local pain relieving effect with minimal systemic absorption. However, direct head-to-head comparisons are relatively few, and a rigorous assessment of the relative efficacy and safety of the various treatment options is lacking. The objective of this study was to compare 5% LMP for the relief of PHN with other relevant interventions and placebo. Six databases were searched up to May 2010. Quantitative methods for data synthesis were used, and a network meta-analysis was conducted. Twenty unique studies (32 publications) were included. Placebo-controlled studies showed 5% LMP to be effective in providing pain relief and reducing allodynia while adverse event rates were generally low. A comparison between 5% LMP and pregabalin indicated the non-inferiority of 5% LMP for pain reduction and showed greater improvement of quality of life for 5% LMP. Adverse events (AE) were significantly fewer with 5% LMP. In the network meta-analysis, only 5% LMP and gabapentin were associated with a greater change in pain from baseline than placebo [-15.50 (95% CI -18.85 to -12.16) and -7.56 (95% CI -12.52 to -2.59) respectively]. 5% LMP was shown to be more effective than capsaicin [-16.45 (95% CI -20.04 to -12.86)], gabapentin [-7.95 (95% CI -13.29 to -2.61)] and pregabalin [-13.45 (95% CI -19.19 to -7.71)]. For pain relief, two comparators were more effective than placebo [mean pain relief, gabapentin: 32.77 (95% CI 15.57-49.97); 5% LMP: 26.77 (95% CI 9.11-44.43)]. 5% LMP was shown to be comparable to gabapentin [-6.00 (95% CI -25.32-13.32)]. The results suggest that 5% LMP and gabapentin have similar effects on pain relief and that 5% LMP is more effective than capsaicin and pregabalin (change in pain from baseline). Topical agents, such as 5% LMP, are associated with fewer and less clinically significant AE than is the case for systemic agents. However, small numbers, and limited size and quality of included studies should be taken into account. Further studies are needed.

[Breaking new ground in teaching medical students emergency medicine. Evaluation of a multi-centre student-guided teaching concept]. / Neue Wege in der Notfallausbildung von Medizinstudierenden. Evaluation eines multizentrischen, studentisch geleiteten Kurskonzepts.

BACKGROUND: Medical students who want to apply for preliminary medical examinations in Germany have to prove that they have attended a first-aid course. However, lay courses are often not up to the standards and needs that medical students require. As a result since 1996 members of the task group "AGEHMED", all of whom are medical students, have been teaching their peers in target groups orientated first aid and emergency techniques at medical school. The task group is (currently) active with 190 students at 6 German medical schools. All students, even those without any previous knowledge, can participate in emergency medicine education of their peers following a supervised 5-step model. OBJECTIVE: The aim of this study was to examine the results of a questionnaire that was used for evaluation of peer-guided first-aid courses at medical schools over the last 7 years and to assess its validity and reliability. MATERIALS AND METHODS: From 2000 to 2007 59 first-aid courses with 4,941 medical students were evaluated. After carrying out descriptive analyses the factorial validity and reliability (Cronbach's alpha) of the questionnaire were assessed. The inter-scale correlation of the significant factors was also analysed. RESULTS: The courses were continuously well rated. The amount of variance explained by the factors"quality of the course","learning success","comparison to other university courses","overall satisfaction" and"scheduling of the course" was 68%. The mean inter-scale correlation was r=0.23 and Cronbach's alpha was between 0.62 and 0.81. CONCLUSIONS: The peer-guided courses have been continually well received by the course participants over the last 7 years. The questionnaire shows sufficient validity and reliability. Based on these results, it can be presumed that this approach can be more widely put into practice in the education of medical students.