Topical Menthol Cream for Refractory Localized Neuropathic Pain: A Multicenter Retrospective Study

To assess the real-world effectiveness and tolerability of stepwise titration with compounded topical menthol in refractory localized neuropathic pain. We conducted a multicenter retrospective chart review in two French pain centers between March 2022 and September 2023. Adults with localized neuropathic pain, baseline pain intensity >4/10, DN4 ≥ 4, and previous treatment failure or intolerance received pharmacy-compounded menthol cream titrated from 1% to 10% over approximately 60 days. The primary endpoint was responder rate at the final concentration used, defined as ≥30% reduction in numerical rating scale pain intensity and/or ≥30% self-reported pain relief. Twenty-one patients were analyzed; 76% were women and 71% had chemotherapy-induced peripheral neuropathy. Mean pain intensity decreased from 6.83 at baseline to 4.82 at 10%, with significant improvement from 3% onward. At 10%, 12/21 patients met the response criterion. Treatment was generally well tolerated, with mostly mild transient local adverse effects. Progressively titrated topical menthol up to 10% may be a practical, accessible, and well-tolerated option for refractory localized neuropathic pain when systemic therapies are ineffective or poorly tolerated. These exploratory findings support titration-based use and warrant randomized placebo-controlled studies to confirm efficacy, refine dosing, and identify responder phenotypes.