Topical Compounded Analgesic Treatment in Neuropathic Pain: 8 years of Experience

Jan M Keppel Hesselink and David J Kopsky

In our tertiary referral centre, the Institute for Neuropathic Pain, we have treated many patients suffering from localized peripheral neuropathic pain since 2009. We have developed, together with a compounding pharmacist, a base cream as a topical formulation which has enabled us to compound creams based on amongst others amitriptyline, ketamine, clonidine, baclofen, and phenytoin. We have found that many patients profit from such topical formulations and we will describe our experiences using such creams over the last 8 years in this paper, since we first started exploring such topical treatments. We have analysed the efficacy and safety of these topicals, and based on literature, our own online data pool and the patients who had let us know that they benefited from the creams, found sufficient analgesia and positive effects impaired sleep, while the tolerability was excellent. Patients suffering from localized peripheral neuropathic pain, as in diabetic neuropathy, chronic idiopathic axonal polyneuropathy, chemotherapy induced polyneuropathy and small fiber neuropathy, as well as in complex regional pain syndrome, seem especially responsive to such topical approach. Meanwhile, more than 800 Dutch medical doctors have been prescribing one or more of our compounded creams, and patients and medical doctors from abroad frequently contact us to explore the therapeutic options for their patients based on these creams.