{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:53:39Z","timestamp":1781621619222,"version":"3.54.5"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Treprostinil, a prostacyclin analogue, is an effective treatment for pulmonary arterial hypertension (PAH). However, continuous subcutaneous infusion is often complicated by severe injection site pain, which can limit continuation of therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report four PAH patients who developed severe injection site pain during subcutaneous treprostinil therapy in the lower abdomen. A hospital-compounded 10% lidocaine gel was applied around the infusion site. Pain was markedly reduced in all cases, with visual analog scale scores improving from 75 to 100\/100 to 0\u201320\/100. In two patients, tramadol could be reduced or discontinued, and all patients were able to continue treprostinil therapy without pain-related limitation or treatment interruption. No systemic adverse effects were observed, although one patient experienced mild local skin irritation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Topical 10% lidocaine gel provided rapid and effective relief of injection site pain associated with subcutaneous treprostinil, facilitating continuation of therapy without pain-related interruption in patients with PAH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40981-025-00834-4","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T05:56:08Z","timestamp":1764395768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of 10% lidocaine gel for injection site pain associated with treprostinil in the treatment of pulmonary hypertension: a report of four cases"],"prefix":"10.1186","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-0855","authenticated-orcid":false,"given":"Shuji","family":"Kawamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariko","family":"Miyao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Sakurai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makiko","family":"Ikeura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Hirotsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kinoshita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritoki","family":"Egi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"834_CR1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1093\/eurheartj\/ehv317","volume":"37","author":"N Gali\u00e8","year":"2016","unstructured":"Gali\u00e8 N, Humbert M, Vachiery JL, et al. 2015 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2016;37:67\u2013119.","journal-title":"Eur Heart J"},{"key":"834_CR2","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1378\/chest.129.3.683","volume":"129","author":"VF Tapson","year":"2006","unstructured":"Tapson VF, Gomberg-Maitland M, McLaughlin VV, Benza RL, Widlitz AC, Krichman A. Safety and efficacy of IV treprostinil for pulmonary arterial hypertension. Chest. 2006;129:683\u20138.","journal-title":"Chest"},{"key":"834_CR3","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1183\/09031936.06.00044406","volume":"28","author":"RJ Barst","year":"2006","unstructured":"Barst RJ, Galie N, Naeije R, Simonneau G, Jeffs R, Arneson C, et al. Long-term outcome in pulmonary arterial hypertension patients treated with subcutaneous treprostinil. Eur Respir J. 2006;28:1195\u2013203.","journal-title":"Eur Respir J"},{"key":"834_CR4","first-page":"333","volume":"34","author":"Y Omori","year":"2014","unstructured":"Omori Y, Onishi Y, Kyotani S. Injection site pain and local reactions associated with subcutaneous treprostinil in Japanese patients with pulmonary arterial hypertension. Prog Med. 2014;34:333\u201348.","journal-title":"Prog Med"},{"key":"834_CR5","unstructured":"Treprost\u00ae package insert. Mochida Pharmaceutical Co., Ltd.; 2021. Available from: https:\/\/www.info.pmda.go.jp\/go\/pack\/2190416A1024_1_11\/?view=frame&style=XML&lang=ja"},{"key":"834_CR6","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1086\/674304","volume":"3","author":"RJ White","year":"2013","unstructured":"White RJ, Levin Y, Wessman K, Heininger A, Frutiger K. Subcutaneous treprostinil is well tolerated with infrequent site changes and analgesics. Pulm Circ. 2013;3:611\u201321.","journal-title":"Pulm Circ"},{"key":"834_CR7","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1016\/j.healun.2010.06.013","volume":"29","author":"MA Mathier","year":"2010","unstructured":"Mathier MA, McDevitt S, Saggar R. Subcutaneous treprostinil in pulmonary arterial hypertension: practical considerations. J Heart Lung Transplant. 2010;29:1210\u20137.","journal-title":"J Heart Lung Transplant"},{"key":"834_CR8","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1164\/ajrccm.165.6.2106079","volume":"165","author":"G Simonneau","year":"2002","unstructured":"Simonneau G, Barst RJ, Galie N, Naeije R, Rich S, Bourge RC, et al. Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med. 2002;165:800\u20134.","journal-title":"Am J Respir Crit Care Med"},{"key":"834_CR9","doi-asserted-by":"publisher","first-page":"90","DOI":"10.2344\/0003-3006-59.2.90","volume":"59","author":"DE Becker","year":"2012","unstructured":"Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. 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Tokyo, Japan: TOP Corporation; [in Japanese]."}],"container-title":["JA Clinical Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-025-00834-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40981-025-00834-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-025-00834-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:09:39Z","timestamp":1781618979000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40981-025-00834-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,29]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["834"],"URL":"https:\/\/doi.org\/10.1186\/s40981-025-00834-4","relation":{},"ISSN":["2363-9024"],"issn-type":[{"value":"2363-9024","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,29]]},"assertion":[{"value":"17 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 November 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work was conducted in the Department of Anesthesia, Kyoto University Hospital, with the approval of the Ethics Committee of Kyoto University Hospital (No. R3381). The work was carried out according to the guidelines of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written consent was obtained from all the patients for publication of this case series.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2"}}