Here is the formula for magical topical pain medication! The idea is by decreasing the sensory input into spinal cord, we may prevent or reverse "central sensitization". By using PLO gel as vehicle, we are able to transfer medication through an intact skin.
You need a compound pharmacist to make this stuff for your patient. We've been lucky to have one of them around our city and a very good one! In this page, you could find the recipe for the two common combination that I use for Neuropathic pain. If you have any question regarding a particular pain syndrome, contact me by email. I am listed in hospital email addresses.
Remember amitriptyline has NMDA blocking properties and could be a better option. However it tends to make the compound "non-homogeneous". If the compound is not in the form of cream, it needs to be mixed before use. The appearance and texture is different based on who is mixing the medication.
Patients need to use a plastic glove to prevent the absorption from their finger! It need to be applied on the location of pain and be rubbed in circular fashion for 5 minutes, 3 times/day for the 1st week and 2 times/day after.