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Those with neuropathic pain received a compound containing 10% ketamine, 6% gabapentin, 0.2% clonidine, and 2% lidocaine. Patients with nociceptive pain were given a compound that contained 10% ketoprofen, 2% baclofen, 2% cyclobenzaprine, and 2% lidocaine. It has amantadine 6%, gabapentin 3%, cyclobenzaprine 2%, lidocaine 5%, clonidine 0.2%, diclofenac 3%, and nifedipine 0.2% in one bottle and I mix it with calcipotriene-betamethisone DP ointment. It actually works really well. The researchers think there was a tiny difference favoring the pain creams because they contained two substances—lidocaine and prescription non-steroidal anti-inflammatory drugs, particularly ketoprofen and diclofenac—that were shown in earlier randomized trials to be effective topically. Topical non-steroidal anti-inflammatories (NSAIDs) and lidocaine are often used as single agents. Less common topical analgesics such as gabapentin, ketamine, and baclofen are often used in a compounded topical cream with three or more medications. Primary Source. Annals of Internal Medicine. Source Reference: Brutcher RE, et al "Compounded Topical Pain Creams to Treat Localized Chronic Pain: A Randomized Controlled Trial" Ann Intern Med Topical gabapentin has been empirically used off-label as a single agent or in combination with amitriptyline and other drugs for neuropathic pain, with a retrospective study suggesting benefit This compounded formulation of Ketamine HCl 10%, Gabapentin 6%, Lidocaine 5%, Baclofen 2%, and Cyclobenzaprine HCl 2% in a topical gel form is designed for targeted treatment and absorption of active ingredients. • antiepileptics (gabapentin, topiramate) • NSAID (meloxicam) • antidepressant (amitriptyline) To more fully assess compounding across pain mechanisms, the committee also examined an additional 10 ingredients that are commonly used in compounded topical pain creams: • anesthetics (ketamine, bupivacaine, lidocaine) These custom-blended agents use a concoction of commonly used drugs. Compounded pain creams differ when used for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine). The neuropathic pain group used cream containing ketamine, gabapentin, clonidine and lidocaine. The cream used by the nociceptive pain group contained ketoprofen, baclofen, cyclobenzaprine and Keywords: Localized neuropathic pain, Topical lidocaine, Topical ketamine, Topical baclofen, Topical amitriptyline, Topical clonidine. Introduction. The International Association for the Study of Pain (IASP) established a clear taxonomy of nociceptive and neuropathic (NP) pain as two different types of pain in 1994 . The distinction between Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine) Nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine) Mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine) Placebo; Cream applied to affected areas 3 times per day 4% amitriptyline, 1% baclofen, 2% ketamine Barton et al, 28 2011 208 Chemotherapy-induced peripheral neuropathy 4 wk Statistically reduced pain 4% amitriptyline, Lockhart, 29 2004 250 Postherpetic neuralgia 3 wk 30% reduction in pain 2% baclofen, 2% amitriptyline Nyirjesy et al, 30 2009 38 Vestibulodynia 33 wk 71% reduction in pain For example, paragraph 0060 states “In particular, the absorption profiles indicate a rapid penetration to a peak flux for gabapentin and baclofen occurring approximately 1 hour after dose application, and between approximately 4 to approximately 10 hours after dose application for ketamine” (Ray and Hodge, 2013). Intervention: Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo. Pain creams tested typically contained one or more of 6 percent gabapentin, 2 percent cyclobenzaprine, 5 percent ketamine, or 5 percent amitriptyline by weight, and also frequently contained ketoprofen, baclofen, clonidine, or lidocaine, which were not analyzed. Nociceptive pain (pain typically caused by injury or inflammation): The active treatment was 10% ketoprofen, 2% baclofen, 2% cyclobenzaprine and 2% lidocaine. Neuropathic pain (pain due to nerve injury): The active treatment was 10% ketamine, 6% gabapentin, 0.2% clonidine, and 2% lidocaine. Amitriptyline 277 Gabapentin 171 Baclofen 213 Ibuprofen 206 women with generalized vulvodynia while topical lidocaine in women with no detectable ketamine and Compounded cream (gabapentin/lidocaine/clonidine/ketamine topical cream, percentages or mg of each API not given), patient was also taking the following oral medications: neurontin (gabapentin) 100 mg per day increased to 200 mg, and ibuprofen 200 mg.
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