Topical amitriptyline versus lidocaine in the treatment of neuropathic pain

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Clin J Pain. 2008 Jan;24(1):51-5.

Topical amitriptyline versus lidocaine in the treatment of

neuropathic pain.

Ho KY, Huh BK, White WD, Yeh CC, EJ.

Department of Anaesthesia and Surgical Intensive Care, Singapore

General Hospital, Singapore.

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.