Topical amitriptyline versus lidocaine in the treatment of neuropathic pain.

Abstract

OBJECTIVE:

Oral amitriptyline, a tricyclic antidepressant, is effective for treating neuropathic pain. We conducted a double-blind, randomized, placebo-controlled crossover study to evaluate the efficacy of topical 5% amitriptyline and 5% lidocaine in treating patients with neuropathic pain.

METHODS:

Thirty-five patients with postsurgical neuropathic pain, postherpetic neuralgia, or diabetic neuropathy with allodynia or hyperalgesia were assigned to receive 3 topical creams (5% amitriptyline, 5% lidocaine, or placebo) in random sequence. The primary outcome measure was change in pain intensity (baseline vs. posttreatment average pain) using a 0 to 100 mm Visual Analog Scale. Secondary outcome measures included the McGill Pain Questionnaire, requirement for rescue medication, and patient satisfaction. Primary statistical comparisons were made with paired t tests or signed-rank tests.

RESULTS:

A reduction in pain intensity was observed with topical lidocaine (P<0.05). No significant change in pain intensity was found with topical amitriptyline or placebo. In pairwise comparison of treatments, topical lidocaine and placebo each reduced pain more than topical amitriptyline (P<0.05).

DISCUSSION:

This randomized, placebo-controlled crossover study examining topical 5% amitriptyline and 5% lidocaine in the treatment of neuropathic pain showed that topical lidocaine reduced pain intensity but the clinical improvement is minimal and that topical 5% amitriptyline was not effective.

• Authors: Kok-Yuen Ho, Billy K Huh, William D White, Chun-Chang Yeh, Eric J Miller
• Journal: The Clinical journal of pain (Clin J Pain) Vol. 24 Issue 1 Pg. 51-5 (Jan 2008) ISSN: 0749-8047 [Print] United States
• PMID: 18180637 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Non-Narcotic
• Anesthetics, Local
• Amitriptyline
• Lidocaine

Topics

• Administration, Topical
• Amitriptyline (administration & dosage, adverse effects, therapeutic use)
• Analgesics, Non-Narcotic (administration & dosage, adverse effects, therapeutic use)
• Anesthetics, Local (administration & dosage, adverse effects, therapeutic use)
• Double-Blind Method
• Female
• Humans
• Lidocaine (administration & dosage, adverse effects, therapeutic use)
• Male
• Middle Aged
• Pain (drug therapy, etiology)
• Pain Measurement
• Peripheral Nervous System Diseases (complications)
• Prospective Studies
• Sample Size
• Surveys and Questionnaires
• Treatment Outcome