Neuropathic pain due to chronic idiopathic axonal neuropathy: fast pain reduction after topical phenytoin cream application

Pain due to chronic idiopathic axonal polyneuropathy (CIAP) is often treated with therapies based on general neuropathic pain guidelines, which are mainly developed with randomized clinical trials having valuated treatments for painful diabetic neuropathy (PDN) and post-herpetic neuralgia. No clinical trial studying treatments for patients with painful CIAP has been yet executed, thus only extrapolation of the value of treatments from other neuropathic pain fi elds is possible. Clearly, the pathogenesis and pathophysiology of CIAP will be quite different from that of PDN. Many CIAP patients complain of intolerable side effects of current analgesic medication. In order to help those patients, we developed a treatment-regime consisting of the supplement palmitoylethanolamide and topical formulations of analgesics. This combination is rarely complicated by side effects. One of our most recent topical formulation we developed contains 10% phenytoin, a broad acting voltage-gated sodium-channel blocker. Phenytoin 10% cream can also be used as a stand-alone therapy as we will discuss.