The treatment of neuropathic pain with a topical cream containing 5% amitryptilin helped the patient considerably, and his pain score decreased from 8-9 to 2, the onset of action was 15 minutes and the analgesic effects remained for 4-5 hours. A patient presentation by David J Kopsky, MD, brought to you by the institute for neuropathy and neuropathic pain, Soest, the Netherlands, www.neuropathy.nl

Topical creams in neuropathic pain

For some patients, topical creams are effective in relieving pain. These creams only have a local effect and sometimes an effect on the nerve system as a whole. The creams do not get absorbed significantly into the blood stream, but diffuse in minute quantities in the skin, were the fine nerve fibers are situated.

• Because of this, there are no cognitive side effects, like foggy brain, sleepiness etc with these creams.
• The main creams in this category are topical anesthetics such as lidocaine and chili pepper extract (capsaicin).
• Only side effects that can occur are allergic skin reactions of compounds in the cream.
• Our institute is developing a number of innovative creams, such as amitriptyline cream, and combinations of substances in creams. 
• Topical medications tend to work best for neuropathies in which the major pain is restricted to a specific regions of the body like the feet.
• Creams can be easily combined with oral medication and other threatment modalities, because of hardly any side-effects.
• Patients have a tool to treat their neuropathy.

April 2010, Jan M. Keppel Hesselink, MD, PhD, David J. Kopsky, MD