Americans spend hundreds of millions of dollars on specially formulated topical pain creams. Medicare Part D paid more than half a billion dollars for such prescription products in 2015. Doctors may prescribe these special creams instead of oral medication with the idea that they have fewer side effects. They may also expect topical medicines to provide more focused local benefit. Scientists decided to run a trial to see if patients are getting their money’s worth (Brutcher et al, Annals of Internal Medicine, Feb. 5, 2019).
What Is in the Special Creams Compounded for Pain Relief?
Compounding pharmacies formulate the creams with ingredients such as local anesthetics like lidocaine. They may also include NSAIDs such as diclofenac or the antiseizure drug gabapentin. In some cases, they incorporate the analgesic/anesthetic ketamine and muscle relaxants like baclofen or cyclobenzaprine.
How Did Scientists Study the Special Creams?
The investigators randomly assigned about 400 pain patients to receive a compounded pain cream or a look-alike placebo cream. Those who were supposed to use the special creams were further subdivided. People suffering from nerve or neuropathic pain used one type of cream. Those with nociceptive pain triggered by infection or injury applied a different mix of ingredients. Volunteers with mixed pain, including some varieties of back pain, utilized a different type of compounded cream. All of the volunteers experienced their pain in localized areas, such as the back, the face or a leg.
Participants used a 0-10 pain scale the week before they started using the special creams. They applied their cream three times a day and recorded pain twice daily in a “pain diary,” again using the pain scale. These diaries provided the data on the effectiveness of the creams.
How Well Did the Special Creams Work?
The investigators found that the change in pain score between active drug creams and the placebo creams was not significantly different at the end of three months.
The authors concluded that
“this randomized controlled trial failed to demonstrate meaningful benefit for 3 specially formulated pain creams versus placebo or approved topical pain creams for various pain conditions.”
This study on special creams does not apply to FDA-approved topical medications such as diclofenac cream or gel (Pennsaid, Voltaren Gel). It does suggest, however, that people not getting adequate relief from over-the-counter or prescription oral pain medicine may want to explore other approaches. Some of these harness the power of the mind-body connection to help people make the pain less intrusive. You may wish to listen to Show 1071: How You Can Get Relief from Chronic Pain or read about the potential benefits of mindfulness in managing pain. You might also contemplate acupuncture or even medical marijuana for pain relief, if your doctor agrees that makes sense.