CHEMOTHERAPEUTIC-INDUCED PERIPHERAL NEUROPATHY (CIPN): TOPICAL TREATMENT WITH KETAMINE AND AMITRIPTYLINE. CASE REPORT

Abstract background and objectives: Chronic pain can be a serious sequel in survivors of cancer treatments. The prognosis is associated with the type and invasiveness of the tumor, the duration of pain persistence during treatment, the treatment and the initial effectiveness in controlling pain. Isolated neuropathy affects 7 to 10% (HESSELINK, 2019) of people in general, 33% of patients seen in pain clinics have neuropathies and 20 to 40% of cancer patients, especially those with mixed pains (nociceptive and neuropathic). Its incidence is associated with increased total pain, increased analgesic consumption and poor quality of life (SIMÃO, 2019). About 66% of neuropathies in cancer patients are directly related to the tumor, 20% result from adversities in the treatment of cancer and 10 to 15% from other comorbidities. The prevalence of chemotherapeutic-induced peripheral neuropathy (CIPN) in 6 months can reach 30% of patients (SERETNY, 2014). The aim of this study is to describe the results of using 10% ketamine associated with 10% amitriptyline in saltstable transdermal cream (TRIMBLE, 2016), in a patient diagnosed with CIPN. Case Report: Woman with a primary diagnosis of breast cancer, chronic and late evolution of peripheral neuropathy after chemotherapy and progressive worsening. After treatment failure using dual, due to adverse effects, topical cream with amitriptyline and ketamine started, showing satisfactory results without side effects in a three-month segment. Conclusion: Treatment with 10% ketamine cream, associated with 10% amitriptyline in saltstable transdermal cream, in two daily applications provided a significant improvement in the patient’s pain without adverse effects. Descriptors: Neurodynia, Chronic Pain, Cancer Pain, Local Anesthetics and Chemotherapy.