From the Guidelines

Neuropathic pain patches, such as high-concentration capsaicin patches, are considered a third-line treatment for neuropathic pain (NP).

The high-concentration capsaicin patch has been shown to be efficacious in reducing pain in patients with postherpetic neuralgia (PHN) and painful HIV neuropathy, with sustained reductions in pain for 2 to 3 months after a single application 1.
The patch is applied for a single treatment, and its long-term benefits and safety of repeated applications are unknown, requiring careful evaluation 1.
Topical low-concentration capsaicin is also considered a third-line treatment, but the high-concentration patch has shown greater efficacy in some studies 1.

The treatment approach for NP involves a step-wise approach, starting with assessment and diagnosis, followed by initiation of therapy for the underlying disease, and then symptom treatment with first-line medications such as secondary-amine tricyclic antidepressants (TCAs), selective serotonin norepinephrine reuptake inhibitors (SSNRIs), or calcium channel α-δ ligands 1.
Topical lidocaine or capsaicin patches may be considered for patients with localized peripheral NP, and opioid analgesics or tramadol may be used for acute NP or episodic exacerbations of severe pain 1.

TCAs, such as nortriptyline or desipramine, require careful titration and may have cardiac toxicity, limiting their use in patients with ischemic cardiac disease or ventricular conduction abnormalities 1.
SSNRIs, such as duloxetine or venlafaxine, have shown efficacy in peripheral NP and may be used as first-line treatments, but require careful dosing and monitoring for adverse effects such as nausea or cardiac conduction abnormalities 1.
Calcium channel α-δ ligands, such as gabapentin or pregabalin, require careful titration and may produce dose-dependent dizziness and sedation, and require dosage reduction in patients with renal insufficiency 1.

From the Research

The following guidelines are based on the available evidence:

Neuropathic pain patches, such as lidocaine 5% patches, are recommended for the treatment of localized neuropathic pain, including postherpetic neuralgia and diabetic polyneuropathy 2.
The use of neuropathic pain patches is part of a multimodal and balanced pharmacological therapy approach, focused on the underlying pathophysiological mechanisms 2, 3.
Topical lidocaine and transcutaneous electrical nerve stimulation are recommended as first-line treatments for peripheral neuropathic pain 3.
High-concentration capsaicin patches are recommended as a second-line treatment for peripheral neuropathic pain 3.
The correct identification of patients and pain syndromes is crucial for the therapeutic success of neuropathic pain patches 2.
A comprehensive treatment algorithm for neuropathic pain, including the use of neuropathic pain patches, has been proposed, covering assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy 4.

Lidocaine 5% patches are licensed for the treatment of postherpetic neuralgia, but can also be used for the treatment of different types of superficial neuropathic pain syndromes, such as diabetic polyneuropathy 2.
Capsaicin 8% patches have been shown to be effective and safe in reducing pain in patients with peripheral neuropathic pain, including postherpetic neuralgia and painful diabetic neuropathy 5.
The use of neuropathic pain patches should be guided by clinical practice guidelines and tailored to the individual patient's needs and response to treatment 6, 3.