Topical cream for nerve pain

I'm just wondering if anyone here has experience with a compound prescription for treating nerve pain?  

I saw a podiatrist yesterday for pain/numbness/on and off discomfort in my great toe, which mainly happens when I am sleeping.  I am not diabetic, but I do have peripheral neuropathy in that leg.  He did a few exam moves on my foot and thinks that my nerves are misfiring in that foot and causing the problem.  

He prescribed a compounded cream for me to use to see if it helps with the toe  and gives it a chance to heal on its own.  The cream contains ingredients I am familiar with mainly as oral meds - ketoprophen, gabapentin, amitriptyline and bupivacaine.  I al to use if for 8 weeks and then see him again.  

The pharmacy has to make the cream, so I don't have it yet and can't report if it does or doesn't work.  But I'm wondering if this type of combination works for a toe, why isn't something like this prescribed for other neuropathic pains?  

Does anyone have ideas or experience with this?
Lulu

[Quixotic1]

Hmmm....The site of the problem with neuropathic pain is higher up - in the cord or brain.  So the errant signal will still be sent despite all the meds put on locally.

However, your podiatrist is saying that the nerve ENDS are acting up locally and misfiring at the source.  This is not classic neuropathic pain as we have come to know and love it.  This is one of the major distinctions between peripheral neuropathy and central neuropathy.

Perhaps that is the reason.  ???

Q

[jensequitur]

I have no idea, but I've heard a couple of people say that they use lidocaine patches for their nerve pain - cut them up and stick the pieces on, wherever they're getting a pain.

[doublevision1]

I hadn't considered trying this for the reasons Quix has stated.  I do find temporary relief from the dysesthesia in my hand with various methods: snugly wrapping it in an ace bandage; slathering regular hand cream on it; soaking it in a tepid bath; generally anything that will alter the constant sensation of burning and constriction.  The best relief I get is when I'm just too busy to think about it.

[PastorDan]

I think it will be interesting to hear how well it works for you, Laura.  We'll look forward to progress reports!

[Lulu54]

Yes, we did discuss this as possibly being the peripheral neuropathy vs central neuropathy.  He opted to have me try the cream to figure out which one it was causing the problem - the other option would have been another EMG.  

He said  IF the cream works and dulls the pain, then we will know the pain is from the the PN and not my MS.  He said if the pain continues despite the cream, then we can do more tests.  

His exam including thumping on my inside ankle bone  and on the top of my foot.  He wanted to know if it made my toe tingle, which it did.  He said that told him my problem was most probably nerve related and not something structural in my foot.

The true test will be if my toe doesn't wake me up like it has done for the past couple months.  I don't care if its peripheral or central as long as it lets me sleep.  the nocturia is finally gone and now I have this!! It's always something! LOL

If the errant CNS signal is eventually coming out in the nerve endings I'm wondering if this type of treatment wouldn't at least help to dull the pain with other nerve pain.  Obviously it doesn't because its not prescribed that way....  My brain is trying to wrap around this - thanks for letting me babble out loud!

Lu

[Quixotic1]

"If the errant CNS signal is eventually coming out in the nerve endings"

This phrase is ????.  The nerves are sensory and ONLY carry the signal from the nerve endings in your toes TO the brain where they are perceived.  No sensory signal travels to the toes to "come out."   In the case of central neuropathy the disruption of the signal happens in the spinal cord or the brain.   The nerve endings in the foot/toe are fine and functioning normally.

Your doctor's plan is sound.  Your desire for relief whether or not you have an accurate diagnosis is also sound.

q

It is true that sometimes we can override the errant signal in the CNS with a stronger signal from the nerve endings in the body (in your case the toe) like DB mentioned.  This can be using pressure, other sensroy stimulation like IcyHot or heat or cold,

[Lulu54]

See it's proof positive,  I wrote that my brain is still trying to wrap around this and I did get that backwards.  If you can numb the nerve and get it to not send the signal to the brain that there is pain is the right direction for it to travel.  Now if I can just get my brain to function and receive all these signals  :-)

I'm in a fog these days and hoping to come around, soon!
Lu