(1) Palmitoylethanolamide (P.E.A.), is a naturally occurring fatty acid amide produced within our cells. Since the initial discovery of P.E.A there have been around 500 separate studies on the properties of P.E.A. for human health. It has been shown to help relieve pain, inflammation, fever, boosts the immune system and helps with allergies.
It’s use has been most popular with pain sufferers as it can be used as a natural pain remedy for chronic pain, acute pain, inflammation and neuropathic pain such as diabetic neuropathic pain, sciatic pain, CRPS, pelvic pain and entrapment neuropathic painstates. It has been shown to be very safe and virtually side effect free.
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(2) Low Dose, Combination, Transdermal Pain Therapy (LCTPT)
The theory of LCTPT starts with three medications with complementary modes of action being incorporated into a penetration enhanced topical base. Based on the key roll that the NMDA receptor performs in causing pain and suffering, an NMDA antagonist should be the first primary ingredient. A glutamate/AMPA antagonist second and either an alpha2-agonist, norepinephrine reuptake inhibitor or GABAb agonist, third. If inflammation is implicated a NSAID should also be included. One gram of this starting formula is applied directly to the localised area of pain and to the corresponding dorsal horn area of the involved dermatome. It is applied at eight hour intervals on a regular basis and every two hours in-between, as needed, for breakthrough pain. Dose escalation can occur daily or every other day until pain is relieved or, rarely, if side effects occur. Additional items from the third list should be added (with a different mode of action) after one to two weeks, if required. Again, dose escalation and evaluation should be repeated, if required.
Table 1 lists all the medications that have been used successfully to treat neuropathic pain. Using the guidelines described above a medication is chosen from each category at the appropriate strength and incorporated into the formula. Ingredients are chosen based on the requirements of each individual thus customising their medication. Ongoing changes to the formula may be necessary until the most effective formula is found. This may involve dosage adjustments or changes to the combinations of the types of medications used.
10% Ketoprofen 10% Guafenesin 2% Baclofen
15% ketoprofen, 7% amitriptyline and 5% lignocaine
10% lidocaine, 7% amitriptyline and 7% carbamazepine
Amitriptyline 2%, Carbamazepine 2%, Gabapentin 10%, and Ketoprofen 2%
Baclofen 5%, Gabapentin 5%, Ketoprofen 10%, and Lidocaine 5%
Baclofen 5%, Capsaicin 0.075%, Ketoprofen 10%, and Tetracaine 2%
Capsaicin 0.05% and Ketamine HCl 2%
Capsaicin 0.075% and Ketoprofen 10%
Cyclobenzaprine Hydrochloride 1%, Dextromethorphan Hydrobromide 10%, Guaifenesin 10%, and Indomethacin 20% Penetrating Gel
Gabapentin in strengths of 5%-10%
Ketoprofen in strengths of 2%-10%
Ketoprofen 5% Baclofen 5%
Table 1 Mode of Action Table
|Classification||Drug||Concentration in Topical Base|
|5 – 10%
5 – 10%
|AMPA (Na Channel antagonist)||Gabapentin
2 – 7%
|alpha2-Agonist||Clonidine||0.1 – 0.2%|
|GABAb agonist||Baclofen||2 – 5%|
|NE reuptake inhibitors (TCA’s)||Amitriptyline*
|2 – 7%
2 – 5%
|Non-NMDA Ca Channel antagonists||Nifedipine||2 – 10%|
|Skeletal Muscle relaxer||Guaifenesin||10%|
|L-Type Ca blocker||Nifedipine||2 – 16%|
|Mu agonist||Loperimide||5 – 10%|
|10 – 20%
5 – 15%
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