Thesis on regional integration

Lignocaine 5% patches are currently only licenced for the treatment of post herpetic neuralgia. It is however regularly used 'off licence' for many causes of chronic pain especially neuropathic pain. In the BJA in 2007 (5) a case study was published sighting a patient with CRPS in his right hand who responded very well to the use of lignociane 5% patches. This patient showed an 80% improvement in his pain and movement within two weeks of starting the treatment and had previously shown no improvement with conventional treatments (physiotherapy, neuropathic pain medication, stellate ganglion blockade). A pilot study was carried out in patients with CRPS using 5 % lignocaine patches in 2000 by Devers and his colleagues. They reported moderate pain relief in 81% of the participants. The safety, pharmacokinetics and tolerability of lignocaine 5% patches were studied in 2002 by Arnold and his colleagues (6). They failed to produce a plasma lignocaine concentration above that needed to produce a toxic effect despite applying four plasters 12 hourly. It is therefore a very safe treatment when used within its prescribed limits (no more than three patches at a time for twelve hours followed by a twelve hour break). Lignocaine 5% are an unlicensed but possible treatment option in CRPS. The main problem with the patches are their cost (thirty patches cost £ (7)). However in JM's case the use of the lignocaine patches are currently enabling him to avoid an amputation operation and participate as an economically productive member of society therefore from a health economics point of view are beneficial to all concerned.

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Thesis on regional integration

thesis on regional integration


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