I have been using a Rx cream that contains ketamine/lidocaine/gabapentin in a compounded topical cream for neuropathic pain. It seems to really take the edge off in conjunction with medical marijuana and lyrica. I also occasionally use Nucynta IR for breakthrough pain. This really seems to be effective for me. I was previously using methadone/morphine/fentanyl for this pain. I ended up in hospital in withdrawal after my body basically rejected this medication protocol. Thank goodness for small miracles as I'm now opiate free other than the odd dose of Nucynta.