Hi
This is Siddharth, and I'm new to this forum.
I live in Mumbai, India, and I have had pudendal neuralgia for the last 3 years with pain levels hovering between 2 and 3.
I wanted to inform about a new topical cream Ketriplin containing amitriptyline (4%) and ketamine (2%) has been
recently released by a company called Ajanta Pharmaceuticals in the Indian market. The cream is meant to treat neuropathies and accompanying
problems like allodynia, hyperalgesia and hyperesthesia.
I've been using it since July and in about 4 months my pain is down significantly, to about level 1, and other related symptoms have also
reduced. Out of all the therapies and drugs I've tried, I found this cream to be the most helpful for my symptoms
I wanted to share this on the forum to let sufferers know that such a product exists in the formal market in India. If anybody wishes to try
it to see if it works for them, I would be glad to assist them in arranging for it. Please let me know.
Regards,
Siddharth Chopra
An amitriptyline cream is in the market, benefiting me
-
helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: An amitriptyline cream is in the market, benefiting me
Welcome garth 
Thanks for this info. How did you get the diagnosis of PN or is it something you still need an 'official' diagnosis for ? Getting your symptoms under control in the way you have is great. good for you.
Take care
Helen
Thanks for this info. How did you get the diagnosis of PN or is it something you still need an 'official' diagnosis for ? Getting your symptoms under control in the way you have is great. good for you.
Take care
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: An amitriptyline cream is in the market, benefiting me
Thanks Helen.
In the first year, I just kept running to doctors who invariably were concluding its Irritable Bowel Syndrome because of the weird bowel motions I was having, but that did not explain the pain I was getting in the pelvic floor. But eventually a doctor, a gastroenterologist, said my pelvic floor muscles had got damaged due to chronic straining during motions (straining pulls the pudendal nerve at the exit of the Alcock's canal I learnt later) and that did explain the pain as well. It was like a vicious circle, spoilt pelvic floor muscles and nerves interfered with motions, and I ended up straining, and that led to the nerves getting damaged even more. So I had to break the cycle, avoid straining at all cost, and simultaneously rehabilitate my nerves. Though there was no one test done that concluded PN for me (doctors did things like colonoscopies, defecograms and MRIs, but they were all negative; nerve conduction tests and EMGs for pelvic floor are not easily available in India sadly) but all symptoms were pointing at neuralgia in the pelvic floor.
I even quit my job, my pain level was around 2-3, but work at office was just not happening. I'm back to work now. When PN was in a way diagnosed, some 15 months after first getting symptoms, doctors prescribed me amitriptyline and sertraline, diet changes, physical therapy, relaxation techniques etc and I got some books on these subjects as well. I've tried quite a few things, but which clicked best for me were paradoxical relaxation (a technique designed to rest pelvic floor muscles by Wise and Anderson, from the book 'a headache in the pelvis'), stretching exercises (from Amy Stein's book), infra-red heating pads, drinking benefiber (mixed with water, it really relaxes the digestive tract and pelvic floor), and of late I've been using a topical cream Ketriplin that has amitriptyline in it. My graph just shot up after I started applying the cream on the skin. Though I had been taking moderate dosages of amitriptyline orally for more than a year, I think this cream just flooded the affected area with the substance. Even the weird sensations in the pelvic area are less and I do manage to sit for long periods nowadays. I guess PN sufferers have to just keep trying what suits them best; people respond very differently to different therapies, so I felt like sharing the info about the cream.
How long has it been in your case, and how are things now.
Siddharth
In the first year, I just kept running to doctors who invariably were concluding its Irritable Bowel Syndrome because of the weird bowel motions I was having, but that did not explain the pain I was getting in the pelvic floor. But eventually a doctor, a gastroenterologist, said my pelvic floor muscles had got damaged due to chronic straining during motions (straining pulls the pudendal nerve at the exit of the Alcock's canal I learnt later) and that did explain the pain as well. It was like a vicious circle, spoilt pelvic floor muscles and nerves interfered with motions, and I ended up straining, and that led to the nerves getting damaged even more. So I had to break the cycle, avoid straining at all cost, and simultaneously rehabilitate my nerves. Though there was no one test done that concluded PN for me (doctors did things like colonoscopies, defecograms and MRIs, but they were all negative; nerve conduction tests and EMGs for pelvic floor are not easily available in India sadly) but all symptoms were pointing at neuralgia in the pelvic floor.
I even quit my job, my pain level was around 2-3, but work at office was just not happening. I'm back to work now. When PN was in a way diagnosed, some 15 months after first getting symptoms, doctors prescribed me amitriptyline and sertraline, diet changes, physical therapy, relaxation techniques etc and I got some books on these subjects as well. I've tried quite a few things, but which clicked best for me were paradoxical relaxation (a technique designed to rest pelvic floor muscles by Wise and Anderson, from the book 'a headache in the pelvis'), stretching exercises (from Amy Stein's book), infra-red heating pads, drinking benefiber (mixed with water, it really relaxes the digestive tract and pelvic floor), and of late I've been using a topical cream Ketriplin that has amitriptyline in it. My graph just shot up after I started applying the cream on the skin. Though I had been taking moderate dosages of amitriptyline orally for more than a year, I think this cream just flooded the affected area with the substance. Even the weird sensations in the pelvic area are less and I do manage to sit for long periods nowadays. I guess PN sufferers have to just keep trying what suits them best; people respond very differently to different therapies, so I felt like sharing the info about the cream.
How long has it been in your case, and how are things now.
Siddharth
Last edited by garth on Tue Jan 24, 2012 1:27 pm, edited 1 time in total.
-
helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: An amitriptyline cream is in the market, benefiting me
It's great that what you found has helped you, especially that you are back to work and managing to keep things under control. I've had piriformis syndrome and PN for almost 4 years and I am struggling to get a referral,backto see someone who can help at the moment, which is a shame because I had been getting treatment. I will get it sorted soon I hope and see what is next for me.
Take care and thanks for sharing your information.
Helen
Take care and thanks for sharing your information.
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: An amitriptyline cream is in the market, benefiting me
I am sure you'll sort it all out and be fine very soon. Did you know about a book"Living with Pudendal Neuralgia" by Vanessa Frank, a PN sufferer who is now out of it. It has got a lot of info on treatment options and you're quite likely to stumble upon things you weren't aware of. I took to heat therapy after reading it. Thought it was a worthwhile read.
Take care
Siddharth
Take care
Siddharth
Re: An amitriptyline cream is in the market, benefiting me
Hi Garth,
Thanks for sharing your helpful information. Do you need a prescription to get this
medication? I don't think my Dr. would prescribe anything that wasn't his own idea. He is a real control freak, and I live in a real rural area where there is no real choice when it comes to doctors. Luckily, I like you, have it pretty mild, and as time goes by I think I'm getting better. Do you think that you just have pn and not pne? I wish I could get a hold of Vanessa's book, but she has taken it off the market. I have been in touch with her on facebook an she's not interested in putting it back on. Can you explain heat therapy? Do you think you're getting better?
Thanks
Thanks for sharing your helpful information. Do you need a prescription to get this
medication? I don't think my Dr. would prescribe anything that wasn't his own idea. He is a real control freak, and I live in a real rural area where there is no real choice when it comes to doctors. Luckily, I like you, have it pretty mild, and as time goes by I think I'm getting better. Do you think that you just have pn and not pne? I wish I could get a hold of Vanessa's book, but she has taken it off the market. I have been in touch with her on facebook an she's not interested in putting it back on. Can you explain heat therapy? Do you think you're getting better?
Thanks
Re: An amitriptyline cream is in the market, benefiting me
Hi Laura
I don't think I have nerve entrapment because I have been responding to non-invasive treatments. Entrapment I believe requires invasive treatments, maybe even a decompression surgery for serious cases. I've relied mostly on medication and heat and supplements.
I got my doc to prescribe me the amitriptyline cream, but it was not his idea. I learnt first about it from the webpage of the Institute of Neuropathic Pain, Netherlands http://www.neuropathie.nu/patients-on-y ... yline.html and I thought I'd give it a try. Found some research studies as well advocating use of topical cream for neuropathic pain. This was about an year back, but there was no such product in the market, but I found an Indian company doing clinical trials and sometimes early this year they introduced it in the market. In India, drug distribution is not very well regulated, so if I have a drug prescription, I can buy as much as I want. I believe in the US a pharmacy would give you only the amount your doctor has specified. I have used about 20 tubes (1 tube is 15 grams) already in the last 4 months, and there is definite improvement. I don't know if the improvement can all be attributed to this cream, but it did coincide with using it. Earlier, after a bowel motion, pain used to shoot up and there was pronounced 'golf-ball-in-the-rectum' kind of sensation. But I remember the very first day I used it, these sensations were much lower. I think compounding pharmacies around your area may make it for you. And if you are interested in getting it from India, I don't think it should be a problem. Let me know.
I also bought two heating pads last year which I use daily, one is from Therasage and the other from Venture Heat (this is milder than Therasage, and I like it better), and both give infra-red heat but are based on slightly different technologies. Vanessa also recommends these in her book. Infra-red heat is said to penetrate a couple of centimeters inside the skin. That's what they claim, but even the reviews from users were very favorable. I usually sit on them while I'm on the internet or watching TV, and they do their job. I think the way it works is that heat stimulates the physiology of the area, the blood circulation improves, muscles and nerves relax etc and it speeds up the healing process. Sometimes I make a fold of the pad and get it real close around the anal area (my pain is mostly in the perianal area) and lie down and the results are even better.
Vanessa's not selling the book any more!!! That's sad. If you want I can scan at least the treatment sections and send you an email. Guess it is a bit of a copyright violation, but its ok, we're patients.
Do let me know if you need anything. Shouldn't be a problem at all.
Siddharth
I don't think I have nerve entrapment because I have been responding to non-invasive treatments. Entrapment I believe requires invasive treatments, maybe even a decompression surgery for serious cases. I've relied mostly on medication and heat and supplements.
I got my doc to prescribe me the amitriptyline cream, but it was not his idea. I learnt first about it from the webpage of the Institute of Neuropathic Pain, Netherlands http://www.neuropathie.nu/patients-on-y ... yline.html and I thought I'd give it a try. Found some research studies as well advocating use of topical cream for neuropathic pain. This was about an year back, but there was no such product in the market, but I found an Indian company doing clinical trials and sometimes early this year they introduced it in the market. In India, drug distribution is not very well regulated, so if I have a drug prescription, I can buy as much as I want. I believe in the US a pharmacy would give you only the amount your doctor has specified. I have used about 20 tubes (1 tube is 15 grams) already in the last 4 months, and there is definite improvement. I don't know if the improvement can all be attributed to this cream, but it did coincide with using it. Earlier, after a bowel motion, pain used to shoot up and there was pronounced 'golf-ball-in-the-rectum' kind of sensation. But I remember the very first day I used it, these sensations were much lower. I think compounding pharmacies around your area may make it for you. And if you are interested in getting it from India, I don't think it should be a problem. Let me know.
I also bought two heating pads last year which I use daily, one is from Therasage and the other from Venture Heat (this is milder than Therasage, and I like it better), and both give infra-red heat but are based on slightly different technologies. Vanessa also recommends these in her book. Infra-red heat is said to penetrate a couple of centimeters inside the skin. That's what they claim, but even the reviews from users were very favorable. I usually sit on them while I'm on the internet or watching TV, and they do their job. I think the way it works is that heat stimulates the physiology of the area, the blood circulation improves, muscles and nerves relax etc and it speeds up the healing process. Sometimes I make a fold of the pad and get it real close around the anal area (my pain is mostly in the perianal area) and lie down and the results are even better.
Vanessa's not selling the book any more!!! That's sad. If you want I can scan at least the treatment sections and send you an email. Guess it is a bit of a copyright violation, but its ok, we're patients.
Do let me know if you need anything. Shouldn't be a problem at all.
Siddharth
Last edited by garth on Tue Jan 24, 2012 1:34 pm, edited 3 times in total.
Re: An amitriptyline cream is in the market, benefiting me
Hi Garth,
You are so kind to let us know all this useful information that has helped you. I'd be interested in trying the creme. As I told you (and believe me I have tried so many times) my Dr will not give me anything that he has not thought of himself. So can you discuss how I can get some of this creme?
What you said about heat therapy, I think I have first hand experience. I going to check into the infra-red though. I just use a regular heating pad and I lie on the couch and let it warm the perineal area, and then I massage any muscles that are tight in the area with pretty good results. I have also been using Amy Stein's book for stretches "Heal Pelvic Pain," and I think that helps too.
I finally have more sitting tolerance (none at first) I'm able to sit on a cushion most days without
lot of pain afterwards, but I try not to sit as much as possible. One day I even sat for 2 hours with no after pain, but that is unusual. My biggest flare is when I have to move my bowels. One day I had to move my bowels a bunch of times due to something that did not agree with me and I went from may 0-1 pain level to 2-3 which still isn't bad, but still who needs the pain? It doesn't hurt in the rectum (and I never strain) it hurts where the nerve is (burns)
If at all possible could you copy off the therapy pages of Vanessa Franks book? Thanks again for being so kind.
Laura
You are so kind to let us know all this useful information that has helped you. I'd be interested in trying the creme. As I told you (and believe me I have tried so many times) my Dr will not give me anything that he has not thought of himself. So can you discuss how I can get some of this creme?
What you said about heat therapy, I think I have first hand experience. I going to check into the infra-red though. I just use a regular heating pad and I lie on the couch and let it warm the perineal area, and then I massage any muscles that are tight in the area with pretty good results. I have also been using Amy Stein's book for stretches "Heal Pelvic Pain," and I think that helps too.
I finally have more sitting tolerance (none at first) I'm able to sit on a cushion most days without
lot of pain afterwards, but I try not to sit as much as possible. One day I even sat for 2 hours with no after pain, but that is unusual. My biggest flare is when I have to move my bowels. One day I had to move my bowels a bunch of times due to something that did not agree with me and I went from may 0-1 pain level to 2-3 which still isn't bad, but still who needs the pain? It doesn't hurt in the rectum (and I never strain) it hurts where the nerve is (burns)
If at all possible could you copy off the therapy pages of Vanessa Franks book? Thanks again for being so kind.
Laura
Re: An amitriptyline cream is in the market, benefiting me
Hi Laura
I'm glad to know you're seeing improvement and manage to sit without much discomfort. I also try pretty hard to avoid flare ups. I realized gains can be wiped off if one is not careful, so I just stick steadfast to my diet regime and therapy regime, and pain is now under control. Diarrheic and constipative bms put too much pressure on the pelvic floor. Benefiber helps me to keep it all regulated. My problem is mostly in the sphincter muscles and the adjoining areas of the levator ani muscle, so it really interferes with my bowel motions. But as things are improving, so are the bowel motions.
I'm going to the pharmacist to buy the cream next week, I'm running out too, this weekend I'm not in town. I'll buy for you as well. Send me your address on garth17@gmail.com. I'll courrier the tubes to your address, and I'll send the therapy sections of the book too. One 15g tube is 148 rupees which is under 3 dollars. You can send me the payment, I'll let you know what is the best way to do that.
I showed my doc this http://www.jpain.org/article/S1526-5900 ... 3/abstract but he is a nice guy, patient and goes into details, which is good. I've seen some really tough ones though. Once a doctor told me that my brain was just blowing up the pain. I mean that could be true but how did it help my cause. If only he could live through a single day like I did, he'd be more considerate. In India, awareness is poor about PN, but I guess that is true for most countries.
See how it goes with you with the cream. Maybe you should tell your doc also about it, I mean that sounds safer. Hope it benefits you, and I could send more later.
Take care of yourself
Siddharth
I'm glad to know you're seeing improvement and manage to sit without much discomfort. I also try pretty hard to avoid flare ups. I realized gains can be wiped off if one is not careful, so I just stick steadfast to my diet regime and therapy regime, and pain is now under control. Diarrheic and constipative bms put too much pressure on the pelvic floor. Benefiber helps me to keep it all regulated. My problem is mostly in the sphincter muscles and the adjoining areas of the levator ani muscle, so it really interferes with my bowel motions. But as things are improving, so are the bowel motions.
I'm going to the pharmacist to buy the cream next week, I'm running out too, this weekend I'm not in town. I'll buy for you as well. Send me your address on garth17@gmail.com. I'll courrier the tubes to your address, and I'll send the therapy sections of the book too. One 15g tube is 148 rupees which is under 3 dollars. You can send me the payment, I'll let you know what is the best way to do that.
I showed my doc this http://www.jpain.org/article/S1526-5900 ... 3/abstract but he is a nice guy, patient and goes into details, which is good. I've seen some really tough ones though. Once a doctor told me that my brain was just blowing up the pain. I mean that could be true but how did it help my cause. If only he could live through a single day like I did, he'd be more considerate. In India, awareness is poor about PN, but I guess that is true for most countries.
See how it goes with you with the cream. Maybe you should tell your doc also about it, I mean that sounds safer. Hope it benefits you, and I could send more later.
Take care of yourself
Siddharth
Re: An amitriptyline cream is in the market, benefiting me
Hi Garth, am really interested in cream but unsure how I source in uk. I spoke to Tim pavy on phone last year who is Australias leading pain & pn expert and mentioned that there was a new wonder cream on market that combined these two ingredients, so this is clearly it. He did say the ketamine can have negative effects on some. How do you find taking and where do you apply, is it ok to be rubbed 'inside'? Regards, Chris