Topical cream brings relief for PN

Posted by gastineaurower @gastineaurower, Jul 26, 2021

I have suffered from idiopathic peripheral neuropathy in my feet and legs for 20 years. I have seen neurologists in Alaska, Washington (UW) and finally Mayo. In every instance I have been stuck with pins, and given diet and exercise recommendations, with the occasional prescription of Lyrica (pre-gabalin) or oral amitriptyline — none of which did much good. On several occasions I have questioned why nothing could be done topically. UW told me that the pharmaceutical companies don't put R&D dollars into topicals because the profit margin is low. FINALLY, but ONLY in my response my question, a Mayo neurologist prescribed an ointment composed of ketamine/amitriptyline 5%/2%. It is not a cure, and it is not cheap ($100 for a month supply — my insurance will cover it) but it is the ONLY thing that will let me get a good night's sleep. BUT YOU HAVE TO ASK FOR IT.

Interested in more discussions like this? Go to the Neuropathy Support Group.

@jetsetter

I read an article on the Mayo website cautioning the use of Ketamin cream. Be careful, it sounds dangerous. Know we try everything to help reduce pain because it can be so debilitating, but using this compound may be worse than the symptom you are trying to relieve.

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I can attest to side effects from ketamine - special compound cream. My body has been on fire and pain since the 2 days I used it. It could have been the lidocaine it was mixed with but all my drs let me know no one is allergic to lidocaine.

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@jetsetter

Thank you so much for sharing these resources. I’ve just left the Rheumatologist’s office with an order for an MRI of my leg. He told me that leg cramps, if severe enough, can cause muscle tears. Could be why I am having swelling there, we shall see. Keeping better track of my water intake to prevent becoming dehydrated.

It sounds like you have a lot of pain to bear, I’m so sorry, pain is debilitating. We just have to keep asking questions and trying things until something helps. Good luck!

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Yes, water is important. In addition to the drying symptoms of Sjogren’s, I have to take a lot of meds which are hard on kidneys. I fill up a 20 fl. oz water bottle and keep it with me wherever I sit. I find it helps remind me to drink plenty and it makes it easy to keep track of how much I drink.

I’m glad you have orders for an MRI. Best wishes and let me know how it turns out.

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@athenalee

Yes, water is important. In addition to the drying symptoms of Sjogren’s, I have to take a lot of meds which are hard on kidneys. I fill up a 20 fl. oz water bottle and keep it with me wherever I sit. I find it helps remind me to drink plenty and it makes it easy to keep track of how much I drink.

I’m glad you have orders for an MRI. Best wishes and let me know how it turns out.

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Thanks, I think I set a record for getting an MRI. I left the rheumatologist’s office a little after 8, my husband had a dr appointment near the hospital so he dropped me off while he had his checkup.
I had the MRI order in my hand. When I called scheduling, they had not received the order yet. So the wonderful lady at the front desk faxed it back to them, I called a few minutes later and had an MRI appointment an hour later! Done. It will be interesting to see what turns up.

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@athenalee

Hi. I’m sorry you are suffering. I have similar pain and neuropathy from Sjogren’s. I have Primary Biliary Cholangitis, which caused liver cirrhosis. I had a liver transplant last August. My neuropathy symptoms, plus severe back and join pain, started in the fall. I saw a neurologist in March who thought I might have Sjogren’s, as PBC and Raynaud’s Syndrome (which I also have), are all ancillary. So, labs confirmed it. Many people with Sjogren’s do not get these “extra glandular” symptoms.

My neuropathy continues to increase, although the sharp pains have declined unless I drive for a couple hours, then the pain in my right leg shin area limits my ability to stand. I’ve always ate fairly well, but as recommended by experts and patients regarding neuropathy, as well as for Sjogren’s, I eat no longer eat refined sugar or flour, I have a low carb diet, lots of anti-inflammatory foods, some suggested supplements, and walk a lot and exercise. So, I believe this is helping. I also take 200-300 mg Gabapentin at night.

My back and joint pain is quite severe, however, so my neurologist referred me to a neuromuscular MD who I see in September.

You’ll find excellent patient advice and resources on the Connect neuropathy discussion group, so when I joined I went through all of those. There is also a Sjogren’s discussion which you might find helpful.

This is a good website -https://www.sjogrensadvocate.com/. Ankther website has some good patient discussions on Sjogren’s- https://www.smartpatients.com/. And, there area number of other websites that are helpful. John Hopkins has one of the more detailed websites on Sjogren’s neuropathy. And, there’s medical journal articles you can find by web searching.

Are you under a neurologist’s care? I didn’t get anywhere with Rheumatology Department at John Hopkins, which is the regional medical center for my area. I hope your experience with your rheumatologist is helpful, I do think they are key for long term care.

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Thanks again for the links, I am reading more and more about Sjogren's Syndrome. It can definitely affect the entire body in many different manifestations. I have not yet been seen by a neurologist, although I saw a Physiatrist for a nerve test to confirm my neuropathy diagnosis but I have not had an guidance as to what the test actually means as far as severity or prognosis. I am counting on my Rheumatologist to guide me in the direction need as things develop. Thanks again for this great forum to discuss issues we have. My husband is a great caregiver so far, but he really doesn't want to hear all the details. He assures me we will do whatever we need to get me the care I need. It's really up to YOU to do the legwork and calling and asking. Doctors seem to want to pinpoint one problem and focus on that, or send you on to a specialist, passing you off, as it were, to the next doctor. I'm not giving up.

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@jetsetter

Thanks again for the links, I am reading more and more about Sjogren's Syndrome. It can definitely affect the entire body in many different manifestations. I have not yet been seen by a neurologist, although I saw a Physiatrist for a nerve test to confirm my neuropathy diagnosis but I have not had an guidance as to what the test actually means as far as severity or prognosis. I am counting on my Rheumatologist to guide me in the direction need as things develop. Thanks again for this great forum to discuss issues we have. My husband is a great caregiver so far, but he really doesn't want to hear all the details. He assures me we will do whatever we need to get me the care I need. It's really up to YOU to do the legwork and calling and asking. Doctors seem to want to pinpoint one problem and focus on that, or send you on to a specialist, passing you off, as it were, to the next doctor. I'm not giving up.

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Sjogren’s is pretty weird I have to say. I hope I can find a good Rheumatologist. I think they hold the key. I agree though about the specialists cycle. I wish there was a more wholistic treatment, instead of just looking at the individual symptoms. Some of the larger institutions have more of a team approach to Sjogren’s, starting with rheumatology, but with other specialists on the team. I see a neuromuscular doctor next month, so I’m hoping she’ll offer something.

Are you in Britain? There seems to be several organizations there for Sjogren’s.

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Someone asked about side effects of using a cream compound of 5%ketamine/2%amitriptyline: the scrip lists generic potential side effects for amitriptyline and ketamine, but notes that these should not be expected when applied in a topical cream. I have not experienced any side effects whatsoever.

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@gastineaurower

Someone asked about side effects of using a cream compound of 5%ketamine/2%amitriptyline: the scrip lists generic potential side effects for amitriptyline and ketamine, but notes that these should not be expected when applied in a topical cream. I have not experienced any side effects whatsoever.

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Does anyone know if you Can you get the ketamine/amitriptyline ointment over the counter, Or do you need a prescription from a doctor?

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@martyk

Does anyone know if you Can you get the ketamine/amitriptyline ointment over the counter, Or do you need a prescription from a doctor?

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It is prescription only, and it's expensive: $100 for a month's supply. My insurance covers it.

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Does it just numb that awful dead feeling your feet have in bed, or does it give more feeling to your feet?
I want to be able to feel my feet better on the pedals so I can drive again.

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