Lidocaine patch (brand name: Versatis medicated plaster) is a prescription-only medication, which has limited licensed use in the UK. Lidocaine patch offers a different approach to pain management as compared to standard analgesic drugs. In this post, I will review the use of lidocaine patch for back pain. The main points covered:
- What is lidocaine patch?
- How is the lidocaine patch used?
- What is lidocaine?
- The UK licensed use of lidocaine
- Can you use lidocaine patch for back pain?
- Is lidocaine patch effective in the management of back pain?
- How much lidocaine patch costs?
- Alternative options to lidocaine patch for the treatment of back pain
What is lidocaine patch?
As the name suggests, lidocaine patch is a medicated plaster which contains a local anaesthetic – lidocaine 5%. Lidocaine patch is known by its branded name – Versatis 700 mg medicated plaster. The patch dimensions are 10 cm x 14 cm. Each patch contains 700 mg lidocaine, which is equivalent to 5% of lidocaine in each plaster.
Lidocaine patch is a prescription-only medication meaning a doctor or another qualified prescriber needs to issue a prescription (NHS or private prescription) in order for a patient to get the supply of this medicine.
How is the lidocaine patch used?
One of the most important point on the use of lidocaine patch is the duration of application. Each Versatis patch is applied to the skin and can be worn for up to 12 hours. Patients need to have 12 hours break before application of a new patch. For more details please refer to product information leaflet.
What is lidocaine?
Lidocaine belongs to a group of drugs called local anaesthetics. Local anaesthetics have a different mechanism of actions as compared to ‘standard’ pain relievers which are available in the form of tablets or over the counter patches. Lidocaine blocks nerves locally and therefore stops sending pain signals to the brain.
In the Uk, lidocaine is available as an active ingredient in different over the counter medicines, for example:
- Anbesol liquid (cetylpyridinium chloride, chlorocresol, lidocaine hydrochloride): used as a pain reliever due to recurrent mouth ulcers and denture irritation
- Anbesol Adult Strength Gel (cetylpyridinium chloride, chlorocresol, lidocaine hydrochloride): the same licensed use as the above product.
- EMLA cream (lidocaine, prilocaine): used a local anaesthetic to numb skin before superficial skin procedures or injections and also as a treatment of premature ejaculation.
The UK licensed use of lidocaine patch (Versatis medicated plasters)
Versatis medicated plaster is licensed in the UK for symptomatic relief of neuropathic pain in connection with previous herpes zoster infection (shingles) in adults. The medical name of this condition is post-herpetic neuralgia (PHN).
PHN is a nerve pain which usually affects the area that was affected by shingles. Patients who experience PHN are unlikely to benefit from ‘standard’ painkillers such as paracetamol or ibuprofen. A combination of paracetamol with or without codeine (co-codamol) is recommended as one of the treatment options according to the national guide (NICE, 2017) on PHN management. Other options for the treatment of PHN include drugs which are used for the management of neuropathic pain, such as amitriptyline, duloxetine, gabapentin, or pregabalin (ibid).
Lidocaine plasters are recommended as optional therapy in the elderly population if there is concern about potential side effects of oral medicines or as additional treatment if severe PHN pain is experienced.
Lidocaine patches are not recommended in the management of neuropathic pain. Licensed treatment of lidocaine patch limits its use in the NHS. High price for Versatis medicated plasters reduces its use further.
Can you use lidocaine patch for back pain?
Lidocaine patches have a specific use as described in the above paragraphs. It is possible to use a lidocaine patch for back pain, not necessarily caused by previous shingle infection but for example, due to neuropathic pain. This, however, would be unlicensed use of lidocaine patches.
A doctor can prescribe medicines outside of their license ‘on the basis of an assessment of the individual patient and when it is necessary to meet a specific needs of the patient’ (GMC, n.d.)
Is lidocaine patch effective in the management of back pain?
A small study looked at the effectiveness of lidocaine patches in the management pain caused by three different conditions – post-herpetic neuralgia (PHN), painful diabetic neuropathy (DN), and low-back pain (LBP). It was concluded that lidocaine 5% patch effectively reduces pain in patients moderate to severe chronic pain resulting from all three conditions mentioned previously (Argoff et al., 2004).
This study, however, does not meet standards in term of quality to be included in the NICE guideline (a guide which advices healthcare professionals in the UK on the treatment of conditions) as evidence supporting their preferred use.
Systemic reviews (a study which compares all available evidence), including Cochrane review (Derry et al., 2014), concluded that there is limited evidence from good clinical studies to support the use of lidocaine patches.
How much lidocaine patch costs?
The cost of lidocaine patches applies only to patients who get a private prescription for this medication. When a drug is prescribed on a private prescription, a customer needs to cover the cost of drug supplied plus as additional dispensing fee, which varies between pharmacies, but usually equals to 10%-20% on top of the medication supplied.
The cost of lidocaine patches (Versatis medicated plasters) is £72.40 for a box of 30 patches (price source AAH Pharmaceuticals, October 20′). With an additional dispensing fee patient can be expected to pay around £90 for a box of 30 lidocaine patches.
Patients who get medicines prescribed on the NHS prescription pay a standard prescription fee or get medication for free, when exempt from paying.
Alternative treatment options to lidocaine patch
Staying in the area of back pain management with patches only, products listed below represent a few options for back pain management. A more comprehensive review of drugs/products available for back pain will follow.
1. Nurofen patches – a medicated plaster containing 200mg of ibuprofen (NSAID)
2. Voltarol Medicated Plasters – a medicated plaster containing 140mg of diclofenac (NSAID)
3. Cura Heat Back & Shoulder Pain
4. Deep Heat Pain Relief Heat Patches
5. Salonpas Pain Relief Patch – a medicated patch containing Methyl Salicylate 105mg & Levomenthol 31.5mg
Argoff CE, Galer BS, Jensen MP, Oleka N, Gammaitoni AR. Effectiveness of the lidocaine patch 5% on pain qualities in three chronic pain states: assessment with the Neuropathic Pain Scale. Curr Med Res Opin. 2004;20 Suppl 2:S21-8. doi: 10.1185/030079904X12960. PMID: 15563743. Available at: https://doi.org/10.1185/030079904×12960 Accessed on 31/10/2020
Derry S, Wiffen PJ, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev. 2014;2014(7):CD010958. Published 2014 Jul 24. doi:10.1002/14651858.CD010958.pub2 Available at: https://dx.doi.org/10.1002%2F14651858.CD010958.pub2 Accessed on 01/11/2020
GMS (n.d.) Prescribing unlicensed medicines. Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices/prescribing-unlicensed-medicines Accessed on 31/10/2020
NICE (2017). Post-herpetic neuralgia: management. Available at: https://cks.nice.org.uk/topics/post-herpetic-neuralgia/management/management/ Accessed on 31/10/2020