***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Recent consensus guidelines recommend pregabalin as a first-tier treatment for painful diabetic peripheral neuropathy ( DPN ) . We evaluated the efficacy of pregabalin 600 mg/d ( 300 mg dosed BID ) versus placebo for relieving DPN-associated neuropathic pain , and assessed its safety using objective measures of nerve conduction ( NC ) . Methods In this r and omized , double-blind , placebo-controlled trial , the primary efficacy measure was endpoint mean pain score ( MPS ) from daily pain diaries ( 11-point scale ) . NC velocity and sensory and motor amplitudes were assessed at baseline , endpoint , and end of follow-up ( 2 weeks post-treatment ) . At each timepoint , the median-motor , median-sensory , ulnar-sensory , and peroneal-motor nerves were evaluated . Secondary efficacy measures included weekly MPS and proportion of responders ( patients achieving ≥50 % reduction in MPS from baseline to endpoint ) . After 1-weeks ' dosage escalation , pregabalin-treated patients received 300 mg BID for 12 weeks . Results Eighty-two patients received pregabalin and 85 placebo . Mean duration s were 10 years for diabetes and ~5 years for painful DPN . Pregabalin-treated patients had lower MPS than controls ( mean difference , -1.28 ; p < .001 ) . For all four nerves , 95 % CIs for median differences in amplitude and velocity from baseline to endpoint and baseline to follow-up included 0 ( ie , no significant difference vs. placebo ) . Significant pain improvement among pregabalin-treated patients was evident at week 1 and sustained at every weekly timepoint . More pregabalin-treated patients ( 49 % ) than controls ( 23 % ) were responders ( p < .001 ) . Conclusion Pregabalin 600 mg/d ( 300 mg BID ) effectively reduced pain , was well tolerated , and had no statistically significant or clinical ly meaningful effect on NC in patients with painful DPN.Trial registration Clinical Trials.gov & NA ; Post‐herpetic neuralgia ( PHN ) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly .  Topical local anesthetics have shown promise in both uncontrolled and controlled studies . Thirty‐five subjects with established PHN affecting the torso or extremities completed a four‐session , r and om order , double‐blind , vehicle‐controlled study of the analgesic effects of topically applied 5 % lidocaine in the form of a non‐woven polyethylene adhesive patch .  All subjects had allodynia on examination . Up to 3 patches , covering a maximum of 420 cm2 , were applied to cover the area of greatest pain as fully as possible . Lidocaine containing patches were applied in two of the four 12‐h‐long sessions , in one session vehicle patches were applied , and one session was a no‐treatment observation session . Lidocaine containing patches significantly reduced pain intensity at all time points 30 min to 12 h compared to no‐treatment observation , and at all time points 4–12 h compared to vehicle patches . Lidocaine patches were superior to both no‐treatment observation and vehicle patches in averaged category pain relief scores . The highest blood Lidocaine level measured was 0.1 & mgr;g/ ml , indicating minimal systemic absorption of Lidocaine . Patch application was without systemic side effects and well tolerated when applied on allodynic skin for 12 h. This study demonstrates that topical 5 % Lidocaine in patch form is easy to use and relieves post‐herpetic neuralgia An 8-week double-blind , multicenter , parallel study compared the safety and efficacy of topical capsaicin and oral amitriptyline in patients with painful diabetic neuropathy involving the feet . Two hundred thirty-five patients were r and omized to treatment with either capsaicin cream or amitriptyline capsules . Capsaicin-treated patients received inactive capsules , and amitriptyline-treated patients applied vehicle cream . A visual analogue scale of pain intensity and measurements of interference by pain with functional activities were recorded at onset and at 2-week intervals . A visual analogue scale of pain relief and physicians ' global evaluation assessed changes in pain status from baseline . Topical capsaicin and oral amitriptyline produced equal and statistically significant improvements in pain over the course of the study . By the end of week 8 , 76 % of patients in each group experienced less pain , with a mean reduction in intensity of more than 40 % . By the end of the study , the interference with daily activities by pain had diminished significantly ( P = .001 ) in both groups , including improvements in sleeping and walking . No systemic side effects were observed in patients treated with topical capsaicin . Most patients receiving amitriptyline experienced at least one systemic side effect , ranging from somnolence ( 46 % ) to neuromuscular ( 23 % ) and cardiovascular ( 9 % ) adverse effects . Topically applied capsaicin is an equally effective but considerably safer alternative to amitriptyline for relief of the pain of diabetic neuropathy An 8-week , double-blind , vehicle-controlled study was conducted to determine the effectiveness of topical capsaicin 0.075 % cream in relieving  pain associated with diabetic neuropathy . Patients were selected who experienced moderate to very severe pain , which interfered with sleep or activities on a daily basis , and who were unresponsive or intolerant to conventional therapy . The results after 8 weeks showed a statistically significant difference in favor of the capsaicin-treated patients , with 90 % of these patients improved . The results of this study indicate that topical capsaicin 0.075 % cream is safe and effective in managing painful diabetic neuropathy The objective of this study was to compare the efficacy and tolerability of gabapentin and amitriptyline monotherapy in painful diabetic neuropathy . This was a 12-week , open-label , prospect i ve , r and omized trial . Twenty-five type-II diabetic patients with pain attributed to diabetic neuropathy and a minimum score of 2 on a pain intensity scale ranging from 0 ( no pain ) to 4 ( excruciating pain ) were r and omized to receive either gabapentin , titrated from 1,200 mg/day to a maximum of 2,400 mg/day , or amitriptyline , titrated from 30 mg/day to a maximum of 90 mg/day . Both drugs were titrated over a 4-week period and maintained at the maximum tolerated dose for 8 weeks . The main outcome measures were weekly pain intensity and paresthesia intensity , measured on two categorical scales . Thirteen patients received gabapentin and 12 received amitriptyline .  All 25 patients completed the trial .  Gabapentin produced greater pain reductions than amitriptyline ( mean final scores were 1.9 vs. 1.3 points below baseline scores ; P = 0.026 ) . Decreases in paresthesia scores also were in favor of gabapentin ( 1.8 vs. 0.9 points ; P = 0 . 004 ) . Adverse events were more frequent in the amitriptyline group than in the gabapentin group : they were reported by 11/12 ( 92 % ) and 4/13 ( 31 % ) of patients , respectively ( P = 0.003 ) . Side effects were the main limiting factor preventing dose escalation . Gabapentin produced greater improvements than amitriptyline in pain and paresthesia associated with diabetic neuropathy . Additionally , gabapentin was better tolerated than amitriptyline . Further controlled trials are needed to confirm these preliminary results Postherpetic neuralgia ( PHN ) following herpes zoster is a common and disabling neuropathic pain syndrome . In a double‐blind , three‐session study , 5 % lidocaine gel or vehicle was applied simultaneously to both the area of pain and to the contralateral mirror‐image unaffected skin . In the local session , lidocaine gel was applied to the painful skin area . In the remote session , lidocaine gel was applied to mirror‐image skin . In the placebo session , vehicle was applied bilaterally . For cranial PHN , gel was applied without occlusion for 8 hours . For limb or torso PHN , gel was applied under occlusion for 24 hours . The 16 subjects with cranial PHN  reported pain relief significantly favoring local drug application at 30 minutes , 2 , 4 , and 8 hours . The 23 subjects with torso or limb PHN reported significantly lower pain intensity with local drug application at 8 hours and both pain relief and reduced pain intensity at 24 hours . Remote lidocaine application to mirror‐image skin was no different from placebo . No systemic adverse effects were reported and blood levels did not exceed 0.6 μg/ml . Topical application of 5 % lidocaine gel relieves PHN pain by a direct drug action on painful skin ABSTRACT Objective : Neuropathic pain is often difficult to treat due to a complex pathophysiology . This study evaluated the efficacy , tolerability and safety of combination therapy with 5 % lidocaine medicated plaster and pregabalin for neuropathic pain in patients with post-herpetic neuralgia ( PHN ) or painful diabetic polyneuropathy ( DPN ) . Methods : Patients completing 4-week monotherapy with 5 % lidocaine medicated plaster or pregabalin were enrolled in an 8-week combination phase . Patients with adequate response to monotherapy ( recalled average pain intensity of 4 or less on 11-point numeric rating scale in the previous 3 days [ NRS-3 score ] ) continued their previous therapy , whereas those with insufficient response received combination therapy . Efficacy endpoints included change in NRS-3 from combination phase baseline , Patient and Clinical Global Impression of Change ( PGIC/CGIC ) , and patient 's satisfaction with treatment . Safety evaluation included adverse events ( AEs ) , drug-related AEs ( DRAEs ) , and withdrawal due to AEs . Clinical trial registration : EudraCT No. 2006 - 003132 - 29 . Results : Of 229 patients in the per- protocol set ( PPS : 68 PHN and 161 DPN ) , 71 received 5 % lidocaine medicated plaster monotherapy , 57 had pregabalin added to 5 % lidocaine medicated plaster , 57 pregabalin monotherapy and 44 received 5 % lidocaine medicated plaster in addition to continued pregabalin treatment . There were no meaningful differences in demographic data between the treatment groups . Patients continuing on monotherapy demonstrated additional decreases in NRS-3 scores . Patients receiving combination therapy achieved clinical ly relevant reduction in NRS-3 values in addition to improvement achieved during the 4 weeks of monotherapy . Improvement was similar between the two combination therapy groups . Considerable improvements in patients ’ treatment satisfaction were reported . Incidences of AEs were in line with previous reports for the two treatments and combination therapy was generally well tolerated . Conclusions : In patients with PHN and painful DPN failing to respond to monotherapy , combination therapy with 5 % lidocaine medicated plaster and pregabalin provides additional clinical ly relevant pain relief and is safe and well-tolerated Neuropathic pain treatment remains unsatisfactory despite a substantial increase in the number of trials . This EFNS Task Force aim ed at evaluating the existing evidence about the pharmacological treatment of neuropathic pain . Studies were identified using first the Cochrane Data base then Medline . Trials were classified according to the aetiological condition . All class I and II controlled trials ( according to EFNS classification of evidence ) were assessed , but lower‐class studies were considered in conditions that had no top level studies . Only treatments feasible in an outpatient setting were evaluated . Effects on pain symptoms/signs , quality of life and comorbidities were particularly search ed for . Most of the r and omized controlled trials included patients with postherpetic neuralgia ( PHN ) and painful polyneuropathies ( PPN ) mainly caused by diabetes . These trials provide level A evidence for the efficacy of tricyclic antidepressants , gabapentin , pregabalin and opioids , with a large number of class I trials , followed by topical lidocaine ( in PHN ) and the newer antidepressants venlafaxine and duloxetine ( in PPN ) . A small number of controlled trials were performed in central pain , trigeminal neuralgia , other peripheral neuropathic pain states and multiple‐aetiology neuropathic pains . The main peripheral pain conditions respond similarly well to tricyclic antidepressants , gabapentin , and pregabalin , but some conditions , such as HIV‐associated polyneuropathy , are more refractory . There are too few studies on central pain , combination therapy , and head‐to‐head comparison . For future trials , we recommend to assess quality of life and pain symptoms or signs with st and ardized tools Neuropathic pain ( NeP ) , generated by disorders of the peripheral and central nervous system , can be particularly severe and disabling . Prevalence estimates indicate that 2 % to 3 % of the population in the developed world suffer from NeP , which suggests that up to one million Canadians have this disabling condition . Evidence -based guidelines for the pharmacological management of NeP are therefore urgently needed . R and omized , controlled trials , systematic review s and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting . Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one method ologically sound , r and omized , controlled trial showing significant benefit relative to placebo or another relevant control group . Recommendations for treatment are based on degree of evidence of analgesic efficacy , safety , ease of use and cost-effectiveness .  Analgesic agents 
    Output:
    
DPN patients experienced a greater improvement in quality of life when using 5%LMP compared to pregabalin .
Adverse events were significantly fewer in patients treated with 5%LMP .
The results suggest that the effects in pain reduction of 5 % lidocaine medicated plaster are comparable to those of amitriptyline , capsaicin , gabapentin and pregabalin .
Topical agents such as 5%LMP may be associated with fewer and less clinical ly significant adverse events than is the case for systemic agents .