Phenytoin cream reduces pain in diabetic neuropathy
In the following video a patient suffering from painful diabetic neuropathy explains how phenytoin cream reduces pain. On the numerical rating scale in which 0 is no pain and 10 is severe pain (NRS), he scored his pain from 9-10 to 2-4 after application the cream.
The 72-year old patient explained he suffered from severe tingling and prickling pain, NRS score 9-10, and after applying phenytoin cream, the pain was reduced to 2-4. He applies cream twice a day, and in case of extra efforts, for instance walking, he applies one time extra. He does not experience any side effects. Now his painful diabetic neuropathy is under control.
Phenytoin is an old anti-epileptic discovered in 1918, and used in the clinic for epilepsy in 1937. Later on topical it showed wound healing properties, and in 2016 we discovered that phenytoin cream can reduce neuropathic pain within 30 minutes (average 15 minutes).
Phenytoin cream works fast
Thus responders are easily tested. The most simple technique is to apply the cream on the painful area and ask the patient after 30 minutes whether the pain is diminished or not. Because this response test is prone to high placebo effect, we developed a placebo-controlled response test.
Most peripheral neuropathies are symmetrical, starting at the feet, and spreading in time up to the knees. This creates the possibility to apply on one foot a placebo cream, and on the other foot phenytoin cream.
When only the doctor knows which cream is placebo and which cream is phenytoin than this is single blind. The most objective way of testing is double-blind. In the double-blind response test (DOBRET) also the doctor does not know which cream is applied on the feet.
After 30 minutes the doctor can break the code and check whether the patient is a responder or not. The ethical issues about using placebo in practice we unfolded in a peer reviewed journal.
August 2018, Jan M. Keppel Hesselink, MD, PhD, revised David Kopsky, December 2018
‘Phenytoin cream reduces pain in diabetic neuropathy’
Watch here our video’s about Neuropathy.
 Kopsky DJ1, Keppel Hesselink JM2. | Single-Blind Placebo-Controlled Response Test with Phenytoin 10% Cream in Neuropathic Pain Patients. | Pharmaceuticals (Basel). | 2018 Nov 12;11(4). pii: E122. doi: 10.3390/ph11040122.
 Keppel Hesselink JM1, Kopsky DJ2, Bhaskar AK3. | Ethical justification of single-blind and double-blind placebo-controlled response tests in neuropathic pain and N-of-1 treatment paradigm in clinical settings. | J Pain Res. | 2019 Jan 14;12:345-352. doi: 10.2147/JPR.S180792. eCollection 2019.