Saw a pain management doc last Friday, and she prescribed an ointment from a compounding phamarcy that consisted of %5 Gabapentin, %5 Lidoderm, and 3% Amitriptyline. They delivered it last night, which is when I started using it. It seemed then like it had more of a numbing effect than Lidoderm cream alone, but I guess that doesn't make sense given its ingredients.

It doesn't seem to be doing much for me today, but I would think it might be one of those things you have to use for a while. I've never seen any mention of such a thing here, and searching for "compounded" doesn't yield any related posts, so I'll report back on how it works or doesn't.

I thought it sounded novel to use an antidepressant and an anticonvulsant in a topical application, but maybe someone here has already heard of it.

Some people on the RSD forum have posted about compounded transdermal creams. If you search that forum you'll find more posts.

Ingredients vary for them too:
Clonodine
Ketamine
Gabapentin
NSAID
Lidocaine
Amitriptyline

All sorts of combos of these may be tried. Doctors tend to use their own formula based on experience.

They work for some people and not others.

MRSD wouldn't a transdermal avoid the first pass metabolism thru the liver? I would think it would be a great idea if you could achieve the necessary pain relief or symptom relief. I wonder if they won't be doing more transdermally in the long run. What do you think?

Yes, it does.

And also, dicolfenac which is one NSAID has recently been shown to cause liver damage when used topically!
http://www.fda.gov/Safety/MedWatch/S.../ucm193047.htm

The concentrations in a cream are not usually very high.
Gabapentin is not metabolized by the liver anyway. So first pass is not an issue.

The whole idea is to reduce the doses, reducing side effects.

Some people really like these formulations, and others not.

Is dicolfenac, Voltaren? I was on that eons ago and got quite sick...hmmm.

Yes, it is Voltaren. My partner has a topical form of it for her polymyalgia, and she keeps saying that I should try it for my NP. I don't know why I've been so resistant to the idea, but have never tried it just to see. I guess if you were sick from it, you didn't notice any benefits from it, if there were any...?

And I think you're right, mrsD. Just because it's topical doesn't mean that it's always benign. After all, you can get poisoned through your skin with a lot of things. But cy has a good point too--that substances don't go through the exact same systems transdermally as they do orally, and that has to be a useful thing for some applications, like avoiding stomach upset/bleeding, maybe?

Well, day two, and I'm not impressed with this stuff yet, but I'm at least going to give it a chance for a few weeks.

The GI bleeding from NSAIDs is a systemic effect, not dependent on swallowing them. A bleed can occur from topicals.

It has to do with prostaglandin suppression.

Wow this is very intersting. I thought the topical was safrer because it was lower dose. I have to tell you that I tried the voltaren gel and

Voltaren or dicolfenac has also casued systemic gout in birds. Just a weird thing I came across with googling.

I currently have a topical that has ketoprophen (?) another NSAID I think. Thinking of switching.

Mrsd D if the NSAIDs suppress prostaglandins I imagine that they do not disthinguish between the good and the bad prostaglandins correct.

So you suppress both. I wonder why thats why I always feel better when I take the borage oil because it helps rebalance the prostaglandins. Just a theory

Only Celebrex is left of the Cox-2 specific NSAIDs...and it is not 100% specific.

All the rest suppress Cox-2 and Cox-1. It is the Cox 1 that gets to the GI bleeds. The Cox-2 when suppressed too much gets to the heart attacks (because suppression of prostacyclin--a Cox 2 that dilates blood vessels is blocked).

Voltaren may just be more liver toxic than the others. It was in the past just a me-too drug put out by Searle to compete with Naprosyn and Ibuprofen. Because it is lipophilic it is used topically to cross the fatty skin layer better.