Topical Phenytoin in Neuralgic Pain, Peripheral Modulation of Central Sensitization: Two Case Reports
- *Corresponding Author:
- David J Kopsky
Institute for Neuropathic Pain
Vespuccistraat 64-III, 1056 SN
Amsterdam, The Netherlands
E-mail: [email protected]
Received date: January 16, 2017; Accepted date: February 13, 2017; Published date: February 17, 2017
Citation: Hesselink Jan MK, Kopsky DJ (2017) Topical Phenytoin in Neuralgic Pain, Peripheral Modulation of Central Sensitization: Two Case Reports. J Pain Relief 6:284. doi: 10.4172/2167-0846.1000284
Copyright: © 2017 Hesselink JMK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
We herewith describe a topical formulation of phenytoin with a clear analgesic effect in localized neuropathic pain: in post herpetic neuralgia and trigeminal neuralgia. Such topical analgesic effect for phenytoin has not yet been described in literature. We have developed various topical phenytoin formulations and identified a stable cream base in which we compounded a range of concentrations of phenytoin up to 10%. We will present two cases supporting the analgesic effect of phenytoin cream in neuralgic pain, and discuss the putative mechanism of action of phenytoin as a topical analgesic. The essence of both cases is that, apparently, it is possible to down-regulate central sensitization processes via the modulation (inhibition) of peripheral input. This hypothesis was brought forward in 2013 based on neurophysiological data, and our clinical data seem to also support this important chapter in pain treatment. Thus, topical analgesia, in our case based on phenytoin, can play an important role in multimodal therapy of chronic neuropathic pain, related to central sensitization states.