Recent article found relief of resistent neuropathic foot pain with a combination of 3% lidocaine, 0.075% capsiacin, and isosorbide dinitrate (ISDN) 0.4% in cream format
J Pain Symptom Manage. 2010 Feb;39(2):e9-e10.
A new combination cream for the treatment of severe neuropathic pain.
Kopsky DJ, Keppel Hesselink JM. no abstract
- painful diabetic polyneuropathy – pain as burning, squeezing and excruciating
- Pregabalin – not tolerate
- PENS once a week – a little pain relief. (multiple level spinal needle acupuncture)
- cannabis in the evening, amitriptyline 20 mg daily, alpha lipoic acid 600 mg daily, and acetyl-L-carnitine 1000 mg/day – all marginal effect
- topical capsaicin 0.075% by self – no effect
They felt the combo effected several mechanism for pain control:
- ISDN – vasodilate and increases NO in tissues (both decreased in neuropathy)(can cause headaches though)
- Lidocaine – sodium channel effect – also would block the burning from capsaicin
- Capsaicin – C pain fiber substance P depletion
- Mix applied 3 times/day – though found worked better 4-5 times a day before pain resurged.
- Careful washing hands after use (and no eye rubbing)
- during first two weeks, pain went from 98/100 to 40-50/100 – varied from 30-70 in end
- subject was able to resume activities
Comment – sounds like a good mix to me. Our compounding pharmacy in Regina is Hill Ave. Drugs
Amitriptyline and ketamine combo also used for neuropathic pain..