Topical amitriptyline and ketamine in neuropathic pain syndromes: An open-label study
Topical amitriptyline and ketamine in neuropathic pain syndromes: An open-label study
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DOI：
10.1016/j.jpain.2005.04.008
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发表时间：
2005-10-01
期刊：
影响因子：
4
通讯作者：
Sullivan, MJ
中科院分区：
文献类型：
--
作者：
Lynch, ME;Clark, AJ;Sullivan, MJ
28名患有顽固性、中度到重度周围神经病理性疼痛的受试者参加了一项开放的前瞻性试验，考察了外用2%阿米替林/1%氯胺酮乳膏的止痛效果、患者满意度和安全性。结果测量包括11分疼痛强度数字评定量表(NRS-PI)、5分满意度量表、血液化学检查、药物和代谢物水平、尿液分析、心电图和体格检查。对不良事件进行监测。21名受试者完成了试验。在6个月时，受试者报告平均长期疼痛减少34%(标准差=37%)；5名受试者(25%)疼痛减轻50%或更多，1名受试者(5%)疼痛减轻100%。在12个月时，疼痛平均减轻37%(SD=40%)；7名受试者(40%)疼痛减轻50%或更多。在研究结束时，%的受试者对他们的满意度为3/5或更高，2名受试者(10%)没有疼痛。报告的不良事件很少，没有严重的药物相关不良事件。血液水平显示出最小的全身吸收。总而言之，外用2%阿米替林/1%氯胺酮乳膏可长期(6-12个月)减轻患者的疼痛，获得中等至完全的满意度，并且在神经病理性疼痛的治疗中耐受性良好。阿米替林或氯胺酮没有明显的全身吸收。观点：这项研究表明，外用2%阿米替林/1%氯胺酮，持续6-12个月，与治疗神经病理性疼痛的长期止痛效果有关。抗抑郁药和氯胺酮都产生多种药理作用，可能有助于外周镇痛；这些作用包括阻断外周N-甲基-D-天冬氨酸受体，局部麻醉特性，以及与腺苷系统的相互作用。(C)2005年，由美国疼痛协会提供。
Twenty eight subjects with refractory, moderate to severe peripheral neuropathic pain participated in an open label prospective trial examining perceived analgesic effect, patient satisfaction, and safety of topical amitriptyline 2%/ketamine 1% cream. Outcome measures included an 11-point numerical rating scale for pain intensity (NRS-PI), a 5-point satisfaction scale, blood chemistry screen, drug and metabolite levels, urinalyses, electrocardiogram (ECG), and physical examination. Adverse events were monitored. Twenty-one subjects completed the trial. At 6 months, subjects reported an average long-term reduction in pain of 34% (standard deviation [So] = 37%); 5 subjects (25%) achieved 50% or greater reduction in pain and 1 subject (5%) achieved 100% reduction in pain. At 12 months, the average reduction in pain was 37% (SD = 40%); 7 subjects (40%) achieved 50% or greater pain reduction. At the end of the study, 89% of subjects rated their satisfaction as 3/5 or greater and 2 subjects (10%) were pain free. Minimal adverse events were reported and there were no serious medication related adverse events. Blood levels revealed minimal systemic absorption. in conclusion, topical 2% amitriptyline/1% ketamine cream was associated with long-term reduction (6-12 months) in perceived pain, moderate to complete satisfaction, and was well tolerated in treatment of neuropathic pain. There was no significant systemic absorption of amitriptyline or ketamine.Perspective: This study demonstrates that topical 2% amitriptyline/1% ketamine, given over 6-12 months, is associated with long-term perceived analgesic effectiveness in treatment of neuropathic pain. Antidepressants and ketamine both produce multiple pharmacologic effects that may contribute to peripheral analgesia; such actions include block of peripheral N-methyl-D-aspartate receptors, local anesthetic properties, and interactions with adenosine systems. (c) 2005 by the American Pain Society.