[Nebulous]

I'm wondering what to ask my Dr. to prescribe me as far as a cream to ease my burning nerve pain.

What has worked best for you?

Lidocaine, Ketamine, Amitriptyline etc...

[Stacy2012]

I have been reading about Gel of 1% Amitriptyline and 0.5% Ketamine to help burning and want to ask my doctor next week when I go.

[Dr. Smith]

I was just looking that up the other day in the archives... The search criteria I used was cream gabapentin ketamine, Search Entire Posts, and Show Results as Posts . (Links to specific searches don't copy/paste well.)

Most of these compounded creams are based on ketamine & gabapentin; beyond that they may vary somewhat. These posts listed precise ingredients & ratios:
http://neurotalk.psychcentral.com/post1050574-5.html
http://neurotalk.psychcentral.com/post1037548-1.html
http://neurotalk.psychcentral.com/post984577-5.html
and this thread from the Reflex Sympathetic Dystrophy (RSD and CRPS) forum:
http://neurotalk.psychcentral.com/thread188668.html
This one just mentioned ingredients:
http://neurotalk.psychcentral.com/post1022466-7.html
Some versions include capsaicin.

Try the search for more.

Doc

[Nervous1]

My neuro has one mixed up at a compounding pharmacy that contains Dexamethasone/Gabapentin/Lidocaine .01/15/4% PLO

N1

Originally Posted by Nebulous

I'm wondering what to ask my Dr. to prescribe me as far as a cream to ease my burning nerve pain.

What has worked best for you?

Lidocaine, Ketamine, Amitriptyline etc...

[Nebulous]

Cool. Thank you!

A couple of things:

-The compounding pharmacy that I called a couple of days ago didn't think that capsaicin was something they could get though I realize it's not essential.

-When ingested orally it's my understanding that amitryptiline needs to be taken for a while before showing effect. Would this not also apply when administered topically?

[Dr. Smith]

Originally Posted by Nebulous

-The compounding pharmacy that I called a couple of days ago didn't think that capsaicin was something they could get though I realize it's not essential.

Try another compounding pharmacy?

-When ingested orally it's my understanding that amitryptiline needs to be taken for a while before showing effect. Would this not also apply when administered topically?

Probably. ketamine amitriptyline cream turns up some long term studies that suggest that.

One such study http://sullivan-painresearch.mcgill....noct2005_2.pdf states:

In a previous pilot trial, we examined the potential
analgesic effects of a topical formulation of a cream
containing 1% amitriptyline and 0.5% ketamine.25 Although
there was no acute treatment effect during the
2-day placebo-controlled part of the trial, in 11 patients
who took part in the 7-day open phase of the trial, there
was a significant analgesic effect by day 3 of treatment,
which continued to increase to day 7. The results of the
open phase trial suggested that a longer treatment period
was necessary to observe a beneficial effect.

Some of the other studies stated somewhat longer periods.

Doc

[Nebulous]

Thx Doc.

I'm curious if let's say I have a 30g bottle of cream @ 1% amitriptyline, would that mean that there is only 0.3 grams of it in the whole bottle? I'm wondering as many people are already on an SSRI or SNRI.

Btw, has anyone here tried just lidocaine cream (not the ointment) or an OTC lidocaine product such as Dr Numb? Did you find that it helped?

[Dr. Smith]

That sounds right—300mg. in the whole bottle. But I've never used the stuff; how much is applied at one time? If that 30g bottle is a month supply, that's only 10mg/day.

According to at least one of the studies: (haven't checked others)

Blood levels for amitriptyline and ketamine were performed at 7 days to determine whether systemic absorption had occurred.
....
Blood analysis revealed no significant systemic absorption of either agent after 7 days of treatment
http://www.ncbi.nlm.nih.gov/pubmed/12966259

IIRC from reading, the meds stay pretty much in the area where they're applied, so risk of serotonin syndrome should be extremely low/unlikely, but that should be verified.

Doc