• Neuropathic pain is “initiated or caused by a primary lesion or dysfunction in the nervous system”. Managing neuropathic pain can be challenging

• Low-dose naltrexone has seen recent use in central neuropathic pain states such as: fibromyalgia, complex regional pain syndrome, diabetic neuropathy, and multiple sclerosis (MS).

• Topical ketamine has been used off label for these same conditions.

• We describe a rare case of diffuse cutaneous neuropathic pain that, after failing several different neuropathic agents, was trialed on low-dose naltrexone, and ultimately managed with compounded cream.