In the Dutch Pain Journal, “Nederlandstalig Tijdschrift Pijnbestrijding” we recently published an article about topical analgesia for the treatment of neuropathic pain. Read the whole artilce here.
Old co-analgesics such as amitriptyline, ketamine and phenytoin are worth of being re-evaluated in compounded creams for the treatment of peripheral neuropathic pain. We call that process repositioning or repurposing. Due to the different mechanisms of action, these agents can become valuable in the treatment of various forms of peripheral neuropathic pain. There are indications that in a number of these neuropathic pain disorders, the pathogenesis is localized in the epidermis. Small lipophilic co-analgesics such as phenytoin are therefore ideally suited for repositioning in these indications as compounded creams. Since most patients indicate that the analgesic effect of such compounded topical formulation is noticeable within 30 minutes after application, we have developed a placebo-controlled response test for use in practice. We believe that an individualized pain treatment becomes possible in this way, because patients can indicate within 30 minutes which cream they benefit most.