***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 The limitations of current treatments for postherpetic neuralgia ( PHN ) have led to the investigation of localised , non-systemic alternatives . NGX-4010 , a high-concentration ( 8 % ) capsaicin dermal patch , was developed to treat patients with neuropathic pain . We report the results of a r and omised , double blind , 12-week study of the efficacy and safety of one application of NGX-4010 in patients with PHN . METHODS In this multicentre , double-blind , parallel-group trial , 402 patients were r and omly assigned to one 60-min application of NGX-4010 ( 640 microg/cm(2 ) [ 8 % capsaicin ] ) or a low-concentration capsaicin control patch ( 3.2 microg/cm(2 ) [ 0.04 % capsaicin ] ) . Patients were aged 18 - 90 years , had had postherpetic neuralgia for at least 6 months , and had an average baseline numeric pain rating scale ( NPRS ) score of 3 to 9 . The primary efficacy endpoint was percentage change in NPRS score from baseline to weeks two to eight . Analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00115310 . FINDINGS Patients who were r and omly assigned to NGX-4010 ( n=206 ) had a significantly greater reduction in pain during weeks two to eight than did patients who had the control patch ( n=196 ) . The mean changes in NPRS score were -29.6%vs -19.9 % ( difference -9.7 % , 95 % CI -15.47 to -3.95 ; p=0.001 ) . 87 ( 42 % ) patients who received NGX-4010 and 63 ( 32 % ) controls had a 30 % or greater reduction in mean NPRS score ( odds ratio [ OR ] 1.56 , 95 % CI 1.03 to 2.37 ; p=0.03 ) . The patients who had NGX-4010 had significant improvements in pain during weeks two to 12 ( mean change in NPRS score -29.9%vs -20.4 % , difference -9.5 , -15.39 to -3.61 ; p=0.002 ) . Transient blood pressure changes associated with changes in pain level were recorded on the day of treatment , and short-lasting erythema and pain at the site of application were common , self-limited , and generally mild to moderate in the NGX-4010 group and less frequent and severe in the controls . INTERPRETATION One 60-min application of NGX-4010 provided rapid and sustained pain relief in patients with postherpetic neuralgia . No adverse events were associated with treatment except for local reactions at the site of application and those related to treatment-associated pain Uncontrolled studies have indicated that topically applied capsaicin may be a safe and effective treatment for postherpetic neuralgia .  In a double-blind study 32 elderly patients with chronic postherpetic neuralgia were treated with either capsaicin cream or its vehicle for a 6-week period . Response to treatment was evaluated by visual analogue scales of pain and of pain relief , together with changes in a categoric pain scale and in a physician 's global evaluation . Significantly greater relief in the capsaicin-treated group compared with vehicle was observed for all efficacy variables . After 6 weeks almost 80 % of capsaicin-treated patients experienced some relief from their pain . Because capsaicin avoids problems with drug interactions and systemic toxicity , we suggest that topical capsaicin be considered for initial management of postherpetic neuralgia & 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 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 recommended for first-line treatments are certain antidepressants ( tricyclics ) and anticonvulsants ( gabapentin and pregabalin ) . Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine . Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain . Recommended fourth-line treatments include cannabinoids , methadone and anticonvulsants with lesser evidence of efficacy , such as lamotrigine , topiramate and valproic acid . Treatment must be individualized for each patient based on efficacy , side-effect profile and drug accessibility , including cost . Further studies are required to examine head-to-head comparisons among analgesics , combinations of analgesics , long-term outcomes , and treatment of pediatric and central Abstract Background and objective : Postherpetic neuralgia ( PHN ) and diabetic polyneuropathy ( DPN ) are two common causes of peripheral neuropathic pain . Typical localized symptoms can include burning sensations or intermittent shooting or stabbing pains with or without allodynia . Evidence -based treatment guidelines recommend the 5 % lidocaine ( lignocaine ) medicated plaster or pregabalin as first-line therapy for relief of peripheral neuropathic pain . This study aim ed to compare 5 % lidocaine medicated plaster treatment with pregabalin in patients with PHN and patients with DPN . Methods : The study was a two-stage , adaptive , r and omized , controlled , open-label , multicentre trial that incorporated a drug wash-out phase of up to 2 weeks prior to the start of the comparative phase . At the end of the enrolment phase , patients who fulfilled the eligibility criteria were r and omized to either  5 % lidocaine medicated plaster or pregabalin treatment and entered the 4-week comparative phase . The interim analysis represents the first stage of the two-stage adaptive trial design and was planned to include data from the comparative phase for the first 150 r and omized patients of the 300 total planned for the trial . Patients aged ≥18 years with PHN or DPN were recruited from 53 investigational centres in 14 European countries . For this interim analysis , 55 patients with PHN and 91 with DPN ( full- analysis set [ FAS ] ) , r and omly assigned to the treatment groups , were available for analysis . Topical 5 % lidocaine medicated plaster treatment was administered by patients to the area of most painful skin . A maximum of three or 
    Output:
    
Adverse events ( AE ) were significantly fewer with 5 % LMP .
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 clinical ly significant AE than is the case for systemic agents .