Topical Ketamine Cream in the Treatment of Painful Diabetic Neuropathy

Mahoney, James; Vardaxis, Vassilios; Moore, Joshua L.; Hall, Alyson; Haffner, Kyle E.; Peterson, Matthew C

doi:10.7547/1020178

Cited by 42 publications

(8 citation statements)

References 24 publications

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“…A recent study evaluated the effects of topical ketamine in relieving DNP (Table III): 17 patients with DNP were randomly divided into a 5% ketamine cream group or a placebo group. The 5% topical ketamine cream was no more effective than the placebo in relieving pain caused by diabetic neuropathy (100). A limitation of this study was the sample size; therefore the clinical efficacy of ketamine needs to be further evaluated.…”

Section: Topical Pharmacological Treatment Of Dnpmentioning

confidence: 99%

Topical treatments for diabetic neuropathic pain (Review)

et al. 2019

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Diabetic neuropathic pain (DNP) has a huge impact on quality of life and can be difficult to treat. Oral treatment is the most frequently used method for DNP, but its use is often limited by systemic side effects. Topical use of drugs as an alternative option for DNP treatment is currently gaining interest. In the present review, a summary is provided of the available agents for topical use in patients with DNP, including lidocaine plasters or patches, capsaicin cream, gel or patches, amitriptyline cream, clonidine gel, ketamine cream, extracts from medicinal plants including nutmeg extracts and Citrullus colocynthis extract oil, and certain compounded topical analgesics. Furthermore, the potential efficacy of these treatments is addressed according to the available clinical research literature. It has been indicated that these topical drugs have the potential to be valuable additional options for the management of DNP, with adequate safety and continuous long-term treatment efficacy. Compounded topical agents are also effective and safe for patients with DNP and could be another area worthy of further investigation based on the strategy of using low-dose, complementary therapies for DNP. The findings indicate that developing topical drugs acting on different targets in the process of DNP is a valuable area of future research.

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Section: Topical Pharmacological Treatment Of Dnpmentioning

confidence: 99%

Topical treatments for diabetic neuropathic pain (Review)

et al. 2019

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“…The minimal effective dose ranged from 250 to 450 mg/daily 165,166 . Two PC-RCTs of topical ketamine for DPN found no pain intensity reduction 153,226 …”

Section: Findings From Studies Grouped By Chronic Pain Syndromementioning

confidence: 99%

Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials

Nicol

Hurley

Benzon

2017

Anesthesia &Amp; Analgesia

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Chronic pain exerts a tremendous burden on individuals and societies. If one views chronic pain as a single disease entity, then it is the most common and costly medical condition. At present, medical professionals who treat patients in chronic pain are recommended to provide comprehensive and multidisciplinary treatments, which may include pharmacotherapy. Many providers employ non-opioid medications to treat chronic pain, however, for some patients, opioid analgesics are the exclusive treatment of chronic pain. However, there is currently an epidemic of opioid use in the United States, and recent guidelines from the Centers for Disease Control (CDC) have recommended that the use of opioids for non-malignant chronic pain be used only in certain circumstances. The goal of this review was to report the current body of evidence-based medicine gained from prospective, randomized-controlled, blinded studies on the use of non-opioid analgesics for the most common non-cancer chronic pain conditions. A total of 9566 studies were obtained during literature searches and 271 of these met inclusion for this review. Overall, while many non-opioid analgesics have been found to be effective in reducing pain for many chronic pain conditions, it is evident that the number of high-quality studies is lacking and the effect sizes noted in many studies is not considered to be clinically significant despite statistical significance. More research is needed to determine effective and mechanisms-based treatments for the chronic pain syndromes discussed in this review. Utilization of rigorous and homogeneous research methodology would likely allow for better consistency and reproducibility, which is of utmost importance in guiding evidence-based care.

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“…In a placebo-controlled study, 17 patients were randomized into either the treatment ketamine 5% cream or placebo cream 35. The selected vehicle was based on Aquaphor gel, and subsequently the gel was compounded into a cream.…”

Section: First Patent On Topical Formulations Containing Ketamine Andmentioning

confidence: 99%

Bottlenecks in the development of topical analgesics: molecule, formulation, dose-finding, and phase III design

Hesselink¹,

Kopsky²,

Stahl

2017

JPR

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Topical analgesics can be defined as topical formulations containing analgesics or co-analgesics. Since 2000, interest in such formulations has been on the rise. There are, however, four critical issues in the research and development phases of topical analgesics: 1) The selection of the active pharmaceutical ingredient. Analgesics and co-analgesics differ greatly in their mechanism of action, and it is required to find the most optimal fit between such mechanisms of action and the pathogenesis of the targeted (neuropathic) pain. 2) Issues concerning the optimized formulation. For relevant clinical efficacy, specific characteristics for the selected vehicle (eg, cream base or gel base) are required, depending on the physicochemical characteristics of the active pharmaceutical ingredient(s) to be delivered. 3) Well-designed phase II dose-finding studies are required, and, unfortunately, such trials are missing. In fact, we will demonstrate that underdosing is one of the major hurdles to detect meaningful and statistically relevant clinical effects of topical analgesics. 4) Selection of clinical end points and innovatively designed phase III trials. End point selection can make or break a trial. For instance, to include numbness together with tingling as a composite end point for neuropathic pain seems stretching the therapeutic impact of an analgesic too far. Given the fast onset of action of topical analgesics (usually within 30 minutes), enrichment designs might enhance the chances for success, as the placebo response might decrease. Topical analgesics may become promising inroads for the treatment of neuropathic pain, once sufficient attention is given to these four key aspects.

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Topical Ketamine Cream in the Treatment of Painful Diabetic Neuropathy

Abstract: The 5% topical ketamine cream was no more effective than was placebo in relieving pain caused by diabetic neuropathy.

Cited by 42 publications

References 24 publications

Topical treatments for diabetic neuropathic pain (Review)

Topical treatments for diabetic neuropathic pain (Review)

Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials

Bottlenecks in the development of topical analgesics: molecule, formulation, dose-finding, and phase III design

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