The People's Perspective on Medicine

Special Creams Fail to Fight Pain

Researchers found that special creams created by compounding pharmacies are not effective for treating chronic pain. They are pricey, though.

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.”

Learn More:

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.

 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I have used Voltaren gel (both 1% and 2%) twice daily for about 3 years now on my thumb joints to relieve arthritis pain. Used consistently, I notice a significant improvement in symptoms. I have experimented with stopping or decreasing the number of applications and note an increase in pain and swelling. For me, it has decreased the amount of oral NSAID needed to control my symptoms to 3x weekly versus twice a day, which makes a huge difference in my gastric discomfort with the use of Naproxen or Ibuprofen. I am quite grateful for this product.

I have used a compounded cream containing Ketoprofren, Baclofen, and Lidocaine for several years for shoulder pain after dislocating my shoulder. It definitely works as well as injections and any other cream either over the counter or Voltaran or similar prescriptions. I also heard the NFL uses my cream.

I tried Diclofenac after my Dr. prescribed it for my first experience with arthritis in a knuckle of my right hand. I used it for 2 months. I then had a serious episode of gastritis in which I had to stop eating for days to let the inflammation stop. I just happened to receive the Peoples Pharmacy newsletter in which there was an article stating that there was no connection between digestive problems and Diclofenac, even though people were claiming they were experiencing digestive issues while using Diclofenac. I stopped using it. My gastritis disappeared and has not returned. I now use arnica. It seems to work.

I disagree with the findings ….it reminds me of the prior ” research ” that was suppose to prove Guiafenesin was useless. Academicians often quoted it to me. Well, now Mucinex is OTC and recommended by the people who scoffed at its use.

I think the efficacy of these compounded creams depends on the Coumpounding Pharmacy and what materials they use. My compounding pharmacy makes a 5 per cent Lidocaine in Lipoderm cream for me for facial pain that is very effective . They rec NOT refrigerating it but I found that prolongs it’s efficacy. I have actually used the OTC 5 per cent Lidocaine Cream Recticare on my face (don’t laugh) and found it was not as potent as the compounded Lidocaine formula. Recticare works fine with rectal mucosa but it’s not powerful enough to penetrate facial cream effectively

Penetrex helps my an arthritic shoulder and incipient carpal tunnel from typing.

I was prescribed a cream with doxerin hcl 5% and zonalon cre 5% for hip pain. It didn’t help, but I kept what I had left in the fridge. Two yrs later, after the exp date, I had a flare-up of osteoarthritis in my thumb joints which swelled up. I decided to try the cream, and it worked wonders. Overnight my joints went back to normal size, and the pain is much less. I can use my thumbs again. Anytime, I get more pain in my hands, I put it on before going to bed. I am glad I kept it around.

I was told by friends (who also have arthritis in their knees) that when they rubbed Voltaren on their knees, they had to stop because after a month or so their heartburn problems got worse. Since Voltaren is an NSAID, should I avoid Voltaren as well? I have arthritic knees also.

Occasional use of Voltaren Gel shouldn’t pose big risks. the trouble is that arthritis isn’t occasional.

I’ve been prescribed a topical cream for reducing stiffness in my hands. At first I thought it offered minimal relief but after continued use I’m not sure it is doing anything. It can’t compare to taking an Advil, as this gives a significant relief within 30 minutes and lasts for a good part of the day. It’s too bad we can’t take drugs like Advil on a regular basis, as they certainly do help.

I’d like to know more about topical and oral CBD products for chronic neuropathic and arthritis pain.

I have been using otc Pentrex for quite a while, and for me it works much better than Voltaren. I find the rollon more effective than the cream and easier to apply. Naproxen is my go-to for really severe pain. Cortisone injections are very effective for me but wear off.

I have pain in my knees. Have tried different creams over the years on top of receiving cortisone injections every three/four months. I am still suffering with this stiffness in the knee joints. So what else can I use to help with this problem?

Capsaicin creams or lotions were not tested because they could not be “blinded.” You might try one of those to see if it helps.

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