Aims To assess the analgesic ef®cacy of topical administration of 3.3% doxepin hydrochloride, 0.025% capsaicin and a combination of 3.3% doxepin and 0.025% capsaicin in human chronic neuropathic pain. Methods A randomized, double-blind, placebo-controlled study of 200 consenting adult patients. Patients applied placebo, doxepin, capsaicin or doxepin/capsaicin cream daily for 4 weeks. Patients recorded on a daily basis overall pain, shooting, burning, paraesthesia and numbness using a 0±10 visual analogue scale during the week prior to cream application (baseline levels) and for the 4 week study period. Side-effects and desire to continue treatment were also recorded. Results Overall pain was signi®cantly reduced by doxepin, capsaicin and doxepin/ capsaicin to a similar extent. The analgesia with doxepin/capsaicin was of more rapid onset. Capsaicin signi®cantly reduced sensitivity and shooting pain. Burning pain was increased by doxepin and by capsaicin and to a lesser extent by doxepin/capsaicin. Side-effects were minor. One patient requested to continue placebo cream, 17 doxepin cream, 13 capsaicin and 9 the combination of doxepin and capsaicin. Conclusions Topical application of 3.3% doxepin, 0.025% capsaicin and 3.3% doxepin/0.025% capsaicin produces analgesia of similar magnitude. The combination produces more rapid analgesia.

SummaryIn N stu~(v oJ'247jatients who had general anaesthesia,for dental procedures, the incidence ojindividual anxieties was noted using ( I yuestionfiaire completed by the patient. The most common anxieties related to the period before transfer to the operating lhiwtre, intru-operative uwureness and postoperative pain. These anxieties were present in over haw the patients questioned. The follow-up questionnaire was :ompleted by 207 patients in order to indicate which anxieties they would expect to have if they nerded rinaesthesiu in the ,future. All anxieties were less ,frequent than ,found before operation.

The selective 5HT3 receptor antagonist ondansetron, currently used as an antiemetic, may also have analgesic properties. Side effects with a single IV injection are infrequent and usually mild.

Anticonvulsant drugs are commonly used in neuropathic pain. There is anecdotal evidence of an analgesic effect of the anticonvulsant lamotrigine in neuropathic pain, but this is verified by few randomised controlled trials. This randomised, double-blind, placebo controlled trial of examined the effect of lamotrigine in a dose increasing to 200 mg in 100 patients with neuropathic pain. Eight patients failed to attend for review, 18 withdrew early and 74 provided results. There was no statistical difference in age, sex or duration pre-treatment pain in the two groups. Total pain, the character of the pain, sensitivity, numbness, paraesthesia, sleep, mobility, mood, quality of life and analgesic consumption were measured. There was a correlation between burning and numbness (P<0. 01), shooting pain and total pain (P<0.01) and between analgesic consumption and mobility (P<0.05) throughout the study period. There were no correlation between any other measured variable. There was no significant change in any variable measured over the eight week period when lamotrigine was used. It is concluded that at the dose used and using the dose escalation regime described, lamotrigine had no effect on either pain, component pain symptoms or quality of life variables.

While this form of therapy is not commonplace in the terminally ill patient, it could be argued that its use has much merit in that field and should be considered.