A recent study found that patients who use compounded topical pain cream to treat localized chronic pain may be no better off than patients using placebo.
The randomized, controlled trial, published in the Annals of Internal Medicine, took place at a military treatment facility and included 399 patients with localized pain classified as neuropathic (n = 133), nociceptive (n = 133), or mixed (n = 133). Patients were treated with either a pain cream targeting their type of pain (neuropathic pain: ketamine, gabapentin, clonidine, and lidocaine; nociceptive pain: ketoprofen, baclofen, cyclobenzaprine, and lidocaine; or mixed pain: ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine) or placebo. The primary outcome was one-month pain improvement, defined as a pain score reduced by at least two points combined with a score greater than 3 on a 5-point satisfaction scale.
Researchers observed no difference in mean pain score reduction between the treatment and placebo groups in any of the pain classifications— neuropathic pain (−0.1 points [95% CI, −0.8 to 0.5 points]), nociceptive pain (−0.3 points [CI, −0.9 to 0.2 points]), or mixed pain (−0.3 points [CI, −0.9 to 0.2 points])—or for all patients (−0.3 points [CI, −0.6 to 0.1 points]). Positive one-month outcomes were observed in 36% (n = 72) of the treatment group and 28% (n = 54) of the control group (risk difference, 8% [CI, −1% to 17%]).
One of the study’s limitations is its short follow-up time, the researchers noted.
Still, the study authors wrote, “Compounded pain creams were not better than placebo creams, and their higher costs compared with approved compounds should curtail routine use.”
— Annals of Int Med (@AnnalsofIM) February 7, 2019
— Pain Research Forum (@PainResForum) February 8, 2019
Compounded Topical Pain Creams to Treat Localized Chronic Pain | Ann Intern Med | ACP | https://t.co/v0Fj51dmB8
— Scott Wright (@GIMMedEdDoc) February 11, 2019
"Our study of nearly 400 pain patients suggests that people who use these compounded creams and gels are being taken advantage of, because the scientific evidence to support a benefit is not there" https://t.co/pSIQnvBAO6
— JHU Public Health (@JohnsHopkinsSPH) February 9, 2019
— Eric Widera, MD (@EWidera) February 8, 2019
Source: Annals of Internal Medicine