Topical amitriptyline versus lidocaine in the treatment of neuropathic pain

Kok-Yuen Ho, Billy K Huh, William D White, Chun-Chang Yeh, Eric J Miller
Clinical Journal of Pain 2008, 24 (1): 51-5

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.

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