Topical Amitriptyline, Ketamine, and Lidocaine Cream for Neuropathic Pain Control in Pediatric Oncology Patients

Neuropathic pain is a significant point of distress in pediatric oncology patients. While oral pain medications such as acetaminophen, nonsteroid inflammatory drugs, gabapentinoids, and/or opioids are commonly prescribed, they can have adverse effects, may interfere with cancer treatment, and increase patient's pill burden. In adult oncology, topical analgesia with combination ointments such as amitriptyline-ketamine-lidocaine (AKL) have shown some efficacy for neuropathic pain relief, however, no significant data for safety or efficacy of topical analgesia exists in pediatric oncology.

To assess the effects of a compounded AKL cream on neuropathic pain symptoms in a cohort of pediatric oncology patients.

Through a retrospective chart review of children and young adults with cancer who were treated with topical AKL cream over a span of five years, we evaluated pain scores at baseline compared to the 10 days following AKL cream administration. We utilized a mixed effects model to study the association between pain scores and study day and age. Changes from baseline were assessed using contrasts with Dunnett-adjusted P-values.

Of the 53 patients included, all used AKL cream at least once. Pain scores were significantly lower on study days 3-5 and 7-10 than at baseline. Opioid showed a nonstatistically significant decrease over time. Independently, pain scores increased linearly by 0.19 for each additional year of age.

Lower pain scores were achieved in patients using topical AKL cream over the study period. Topical cream can serve as a potential therapeutic adjuvant for cancer-related neuropathic pain in pediatric patients.