Topical Pain Relief?

[cathydownunder]

Many months ago, a forum poster suggested that I use a combination amytriptyline/ketamine combo ointment for pain relief. He stated it worked wonders but is cost prohibitive if having to pay the full price/unsubsidised.

I asked my PM doc last week who said he's used a ketamine/neurontin combo with some other patients with good effect, and he's happy to prescribe the same for me.

Has anyone else used any/all of these? Any side effects?

I'm worried about long term side effects but the info Ive found says very little appears to be absorbed beyond the dermal layers.
Info anyone?

[Harrison]

Cathy, this article may help a little...
________________________________

Topical Amitriptyline and Ketamine in Neuropathic Pain Syndromes: An Open-Label Study

Mary Elizabeth Lynch, , Alexander John Clark†, Jana Sawynok‡ and Michael J. Sullivan§

Pain Management Unit, Queen Elizabeth II Health Sciences Centre and Department Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
†Chronic Pain Centre, Calgary Health Region and Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
‡Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
§Department of Psychology, University of Montreal, Montreal, Quebec, Canada

Received 22 December 2004;
revised 27 April 2005;
accepted 29 April 2005.
Available online 1 October 2005.

Abstract

Twenty eight subjects with refractory, moderate to severe peripheral neuropathic pain participated in an open label prospective trial examining perceived analgesic effect, patient satisfaction, and safety of topical amitriptyline 2%/ketamine 1% cream. Outcome measures included an 11-point numerical rating scale for pain intensity (NRS-PI), a 5-point satisfaction scale, blood chemistry screen, drug and metabolite levels, urinalyses, electrocardiogram (ECG), and physical examination. Adverse events were monitored. Twenty-one subjects completed the trial.

At 6 months, subjects reported an average long-term reduction in pain of 34% (standard deviation [SD] = 37%); 5 subjects (25%) achieved 50% or greater reduction in pain and 1 subject (5%) achieved 100% reduction in pain. At 12 months, the average reduction in pain was 37% (SD = 40%); 7 subjects (40%) achieved 50% or greater pain reduction. At the end of the study, 89% of subjects rated their satisfaction as 3/5 or greater and 2 subjects (10%) were pain free. Minimal adverse events were reported and there were no serious medication related adverse events. Blood levels revealed minimal systemic absorption.

In conclusion, topical 2% amitriptyline/ 1% ketamine cream was associated with long-term reduction (6-12 months) in perceived pain, moderate to complete satisfaction, and was well tolerated in treatment of neuropathic pain. There was no significant systemic absorption of amitriptyline or ketamine.

Perspective

This study demonstrates that topical 2% amitriptyline/1% ketamine, given over 6-12 months, is associated with long-term perceived analgesic effectiveness in treatment of neuropathic pain. Antidepressants and ketamine both produce multiple pharmacologic effects that may contribute to peripheral analgesia; such actions include block of peripheral N-methyl-D-aspartate receptors, local anesthetic properties, and interactions with adenosine systems.

Key words: Neuropathic pain; topical amitriptyline and ketamine; clinical trial

[Jack]

Only thing I could recommend is read up on tri-cyclic anti-depressants(amitriptyline is generic for Elavil). They tend to not get along well with some other drugs. This group of drugs were used for major depression until more modern drugs came along. Ketamine is used in surgery by anesthesiologist to prevent a person from remembering. It also has been know to be used illegally as a date/rape drug.

I don't know about the patch and how much is absorbed with it's delivery system. This would be a good thing to ask your doctor. Blood levels or patch vs pills. The fentanyl patches, and the scopolamine patches create significant blood levels. The lidoderm patches do not. All patches are not created equal.

[tooyoungforthis]

Hey everyone,

Just wanted to add what I use. 10%Ketoprofen, 5% Lidocaine, 10% Baclofen transdermal cream. I like it because I can use it at work, nothing systemic. It takes away from some pain, but not all of course. I first got it as a gel type, but it did not spread very well. Then I got it in more of a lotion/cream and that works really well.

Beth