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Central neuropathic pain in a patient with MS treated successfully with topical Amitriptyline




Abstract

Central neuropathic pain in patients with multiple sclerosis (MS) is a common debilitating symptom, which is mostly treated with tricyclic antidepressants or antiepileptics.

Unfortunately, the use of these drugs is often limited due to adverse events.

We investigated the analgesic effect of topical amitriptyline 5% and 10% cream in a patient with central neuropathic pain due to MS.

The analgesic effect of topical amitriptyline cream on neuropathic pain was dose related.

To evaluate whether this analgesic effect is due to the active compound or placebo, we conducted a double-blind placebo-controlled n-of-1 study with amitriptyline 5% cream and placebo.

The instruction was to alternate the creams every week following the pattern ABAB, with an escape possibility of amitriptyline 10% cream.

The result was a complete pain reduction after application of cream B, while most of the time cream A did not reduce the pain.

The patient could correctly unblind both creams, determining B as active. She noted that in the week of using the active cream no allodynia was present, with a carryover effect of one day.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/1896

n = 1?????

lyndacarol wrote:n = 1?????

Only 1 individual in the study.

Yes, I knew it meant ONE person in the study. I was trying to express my amazement that a study with ONE person should garner so much publicity and obvious credence. If this is going to be the "bar" any number of us here should qualify for the same publicity – at one time or another, each of us has probably had an improvement that we attribute to a particular action.

I was just venting; sorry that I did not express myself clearly.

ummm... I don't get how this is working. I also thankfully do not get central neuropathic pain, so have little understanding of it. Is she applying the cream to where she feels the pain? ie my foot hurts, so I will apply it to my foot?

It sounds to me ALMOST like the doctor saying, "hey, your left leg stopped working, so we will cut it off before the MS spreads to the rest of your body" (sorry, I couldn't resist that one )

I could only see that there is some migration of the drug through the skin, and POSSIBLY directly to the end of the nerve that is connected to the damaged nerve, further up the system in the CNS.