Topical amitriptyline versus lidocaine in the treatment of neuropathic pain.


Journal Article

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.

Full Text

Cited Authors

  • Ho, K-Y; Huh, BK; White, WD; Yeh, C-C; Miller, EJ

Published Date

  • January 2008

Published In

Volume / Issue

  • 24 / 1

Start / End Page

  • 51 - 55

PubMed ID

  • 18180637

Pubmed Central ID

  • 18180637

Electronic International Standard Serial Number (EISSN)

  • 1536-5409

International Standard Serial Number (ISSN)

  • 0749-8047

Digital Object Identifier (DOI)

  • 10.1097/ajp.0b013e318156db26


  • eng