Patient-tailored combinations of systemic and topical preparations for localized peripheral neuropathic pain: a...

This report describes two patients with peripheral neuropathic pain (PNP): a 43-year-old man with upper leg PNP and a 75-year-old woman with post herpetic neuralgia of the perineum and vagina. Pain was inadequately managed in both patients for a long time. A patient-tailored approach, including a combination of systemic and topical compounds, required multiple adjustments for each patient before finally achieving adequate pain control. The first patient achieved pain control with a combination of systemically-administered drugs: dipyrone (1 g 3 times a day), pregabalin (300 mg twice a day), duloxetine (60 mg once daily in the morning), and dextromethorphan (60 mg 3 times/day), plus topical compounds (10% ketamine, 5% lidocaine, and 10% ketoprofen) in penetrating enhancing gel, and sublingual ketamine (10 mg) for breakthrough pain. The second patient achieved optimal pain control with dipyrone (500 mg three times per day), pregabalin (150 mg twice a day), dextromethorphan (60 mg three times per day), plus topical compounds (10% ketamine, 0.3% clonidine, 5% diclofenac) in a penetrating enhancing gel. Notably, the individualized approach described herein was made possible through collaboration between a public health pain specialist and a private sector compounding pharmacist, highlighting the importance of such infrequent but, highly desirable collaborations.