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  • Lidocaine patches, battle between consultant and pharmacist

    I recently fractured my arm after falling over crossing the street, the A&E department offered no pain relief other than OTC medications such as co-codamol and anti-inflammatories, but inadequate analgesia in A&E seems to be a common theme according to the CQC reports so this does not surprise me. However the ridiculous ensuing battle between the hospital and GP practice has done.

    The consultant orthopaedic surgeon after saying that the hospital widely uses lidocaine patches after fractures recommended that I speak to my GP to get a prescription, however after speaking to the pharmacist at the practice the GP wouldn't prescribe lidocaine patches apparently because in the UK it doesn't have a licence for that indication, yet the same GP suggested trying gabapentin which is totally unlicensed and not in any way indicated for musculoskeletal pain!

    After having another x-ray at the hospital today, the doctor that saw me gave me the ridiculous excuse that he couldn't prescribe me the patches his colleague had recommended because he doesn't know me well enough as a patient so can't follow up re-side effects despite me being asked to come back for follow up, and the none of the practice GP's have ever met me! So now a doctor at the GP practice is going to call me back again tomorrow. In the meanwhile I have ordered a few different strength lidocaine patches off ebay (4-15%) as foreign sellers have them in stock and seem to have no trouble getting them through customs. It seems the UK is the only country where you can't just buy them OTC in fact.

    If this were a controlled drug I could perhaps understand but this is a chemical you can buy from general retailers in the UK for personal use and can be trivially precipitated from them as a pure freebase using NaOH or a similar base.

    So now I left self medicating with morphine for the pain instead of using lidocaine patches. Is this a case of CYA (cover your ass) prescribing gone mental? Who is actually right here?

  • #2
    Lidocaine is a local anaesthetic which I have had injected for dentistry. Did not no it could be used as an analgesic. Will now research this on the net. Wonder if could be used for joint or back ache.Thanks for this interesting story.
    johnep

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    • #3
      Our surgery only ever issues these patches as a last resort for pain management, partly because of the cost. The last patient we gave them to had a tumour growing out of her back. Sadly the lady has now died. I’ve never heard of these being issued for a broken arm and would question if they would work or not? Surely the pain comes from the broken bone and I don’t know if the local anaesthetic would even penetrate that far.
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      • #4
        [QUOTE=admin;n242618]Our surgery only ever issues these patches as a last resort for pain management, partly because of the cost. The last patient we gave them to had a tumour growing out of her back. Sadly the lady has now died. I’ve never heard of these being issued for a broken arm and would question if they would work or not? Surely the pain comes from the broken bone and I don’t know if the local anaesthetic would even penetrate that far.[/QUOTE]

        +++1 I am quite puzzled by this since surely the next step should be Buprenorphine (Temgesic) and/or low dose Amitriptyline (10mg). A possible solution is that there was some communication problem and the consultant thought that the patient was complaining about skin irritation due to the plaster cast but I'm not convinced.

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        • #5
          I'm not in plaster, just in a sling.

          The pain does not simply emanate from the fracture itself but from the numerous muscles damaged during the impact of the fall, the whole of my upper arm is tender and bruised.

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          • #6
            Lidocaine also comes as a spray that can be bought from a pharmacy without a prescription.Although I'm not sure how good Lidocaine ould be in your case.

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            • #7
              https://www.england.nhs.uk/wp-conten...e-plasters.pdf

              They usually are seen as a high cost and low evidence option.

              We do not prescribe them at practice level and get emails from the CCG into choosing more "appropriate" alternatives.

              Have other options been explored?

              Hospitals will not know about the formulary that the practice should be adhering to.

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              • #8
                Originally posted by Ap0thecary View Post
                https://www.england.nhs.uk/wp-conten...e-plasters.pdf

                They usually are seen as a high cost and low evidence option.

                We do not prescribe them at practice level and get emails from the CCG into choosing more "appropriate" alternatives.

                Have other options been explored?

                Hospitals will not know about the formulary that the practice should be adhering to.
                These articles arguing against the use of lidocaine all seem to be based on neuralgia not muscoskeletal pain and they are only using the 5% patches when 10% patches are available.

                What alternatives are there other than strong opioids? Drugs like nefopam and tramadol give me significant difficulty urinating at doses that provide analgesia, paracetamol and NSAID's seem useless for severe pain in my case, the choice based on my response to treatment is between morphine which doctors in the UK irrationally won't prescribe unless you are dying and lidocaine.

                Temgesic/buprenorphine is a strong opioid which produces the same effect as morphine in opioid naive individuals such as myself so I can't see the doctor prescribing that either unless their knowledge of pharmacology is poor, mind you if the GP suggested gabapentin it does suggest she isn't the sharpest knife in the drawer...

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              • #9
                Yeah I've tried codeine 60mg 4x a day, no effect whatsoever.

                When I said OTC I meant that codeine is basically an OTC drug, eg taking 2x co-codamol and 3x co-drydamol is 5 x 12.4mg = 62mg codeine. Around 10% of Caucasians can't metabolise it which possibly explains it's atrocious NNT of 16.

                The oxford pain league paints a very poor picture of codeine indeed.

                http://www.bandolier.org.uk/booth/pa...ics/lftab.html

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                • #10
                  If you find that these patches work and Dr will not prescribe (because unlicensed for that indication and making their insurance void), I would order on line.
                  You could also perhaps try the lidocaine gel.
                  johnep

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                  • #11
                    I have 15% lidocaine gel and the ability to create 100% freebase lidocaine but the problem is creating a delivery system that works. I want to reduce my use of morphine but the doctors don't seem to care, it's infuriating.

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                    • #12
                      In Ireland lidocaine patches are only licensed for post herpetic neuralgia but were widely used for all sorts of chronic pain until our health service refused to pay for them in most cases. There was an outcry from many who said they provided the only relief they could get. They are still easily available privately if you can afford them. Could you get a private prescription if your doctor doesn’t think they are worth the NHS paying out for?

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                      • #13
                        In the end I just bought them off ebay, considering how cheap they were I don't see where the cost issue is coming from? Was not given the option of a private prescription, so had to take my chance with buying medications off ebay, nice to see the NHS places cost above patient safety...

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                        • #14
                          Originally posted by Energize View Post
                          In the end I just bought them off ebay, considering how cheap they were I don't see where the cost issue is coming from? Was not given the option of a private prescription, so had to take my chance with buying medications off ebay, nice to see the NHS places cost above patient safety...
                          How cheap were they out of curiosity?

                          I'd be concerned if they were very affordable. Tariff price at the moment is over £70 a pack (30) and the old adage if it's too good to be true is always relevant
                          I remember when a blog was an individual boot.

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                          • #15
                            $20 for a pack of 15, batch code and serial numbers match on the manufacturer's website checker.

                            The UK pays over the odds compared to some other countries due to licencing issues and discounts that pharmaceutical countries give to poorer nations, compare the cost of HIV medication in the UK vs India, massive difference.

                            When drugs become OTC as lidocaine is in other countries it's not uncommon to see a significantly lower price.

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