Journal of pain and symptom management · 2026
Topical Amitriptyline, Ketamine, and Lidocaine Cream for Neuropathic Pain Control in Pediatric Oncology Patients.
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Rav Emily, Sheikh Irtiza N, Cha Yujin, Andersen Clark R, Baig Muhammad U, Harden Avis, Itzep Nelda, Wang Jian, Moody Karen
Аннотация
CONTEXT: 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.
OBJECTIVES: To assess the effects of a compounded AKL cream on neuropathic pain symptoms in a cohort of pediatric oncology patients.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
OBJECTIVES: To assess the effects of a compounded AKL cream on neuropathic pain symptoms in a cohort of pediatric oncology patients.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.