Among those whose insurance has covered it, quite a number of people have gotten some relief from burning pain from compounded gels containing ketamine, among other drugs. "Compounded" means than a specialized pharmacist makes up the order according to the prescription.

And although it’s not my predominate issue, at night, I would develop burning pain in both feet (they were injured almost identically on a piece of gym equipment) for which my doctor has for the last 8 years now prescribed an gel, now containing 10% ketamine, 5% gabapentine and another 5% lidocaine. A month's supply (per what were the insurance company guidelines) consisted of 400 ml. and cost roughly $650, with all but a $60 co-pay being reimbursed by the carrier. The stuff was great. That, and it was the ONLY way I could hope to wear dress shoes and socks for special occasions, not that it always worked. And here's a nice little article on point, Reduction of allodynia in patients with complex regional pain syndrome: A double-blind placebo-controlled trial of topical ketamine, Finch PM, Knudsen L, Drummond PD, Pain 2009 Nov;146(1-2):18-25. Epub 2009 Aug 22, FULL TEXT @ http://www.rsds.org/pdfsall/Finch_Knudsen_Drummond.pdf

The only problem is that after many years of picking this up, the pharmaceutical carrier recently issued a formal "Notice of Adverse Benefit Determination" on the sole ground that drugs costing less than ketamine “may” be equally effective. Oddly, two weeks earlier it issued a separate notice on the grounds that the pharmacist didn’t specify the cost of every item in the compound – having never made this request before - that has since been rectified, on account of which I'm just resubmitting as corrected. That way, if ketamine remains a problem, I can then deal with it in isolation. Getting a letter from my doctor, etc.

The only reason I mention this is that, from my pharmacist and others, I’ve heard of this happening to a number of people, as though a decision was made somewhere on high, in which case all the doctors’ letters in the world may not make a difference. (But in case they might, it wouldn’t hurt to give your MD a copy of the study by Finch et al: please note that the full citation is not on the PDF copy on file with the RSDSA, where it apparently posted the Epub.)

In any event, I raise the matter to see if others here are experiencing the same thing.

Mike