Non-Opioid Transdermal Analgesics: Are They Effective for Chronic Pain?
SAN ANTONIO — Treatment of numerous chronic pain conditions requires prolonged opioid administration, which is associated with numerous adverse effects. This has prompted identification of alternative treatments that include topical formulations.
During the American Academy of Pain Management's Annual Meeting in San Antonio, Texas, researchers presented results from a study testing the efficacy of a transdermal analgesic in reducing pain levels in patients with chronic neuropathic or musculoskeletal pain.1
This Optimizing Patient Experience and Response to Topical Analgesics (OPERA) observational study was conducted over 5 months with 158 patients (93 females, 58 males) who experienced chronic pain and were administered a topical analgesic containing 20% flurbiprofen, 20% diclofenac, 10% magnesium chloride, 6% gabapentin, 5% amitriptyline, 5% ketoprofen and bupivicaine 2%. The control group consisted of 37 patients who were not given the transdermal analgesic; 20 of these completed the trial (assessment after 6 months).
Pain levels and opioid use were determined using the Brief Pain Inventory (BPI)2 short form and a survey, respectively, prior to and at the conclusion of the 5-month treatment. Patients given the transdermal analgesic reported reduced use of opioids (45%), as well as of anti-inflammatory (71%) and other over-the-counter drugs (51%; P <.001 for all).
In addition, reported pain scores were also reduced following 164.3 ± 24.0 days of treatment with the transdermal patch for all 11 measures included in the BPI, with a reduction of pain severity (43%, P<.001; from 4.7–2.7) and interference (52%, P<.001; from 4.2–2.0) scores, both measured on a 0 to 10 scale.
Study participants did not experience notable side effects, and 60% and 39% reported being “very” and “somewhat satisfied” with the medication, respectively. In the control group (n=20), trends were opposite after 6 months, with increased use of opioids (10–15%), anti-inflammatory (0–40%) and over-the-counter medications (45–90%). In this group, mean BPI severity score was unaffected and interference score increased (3.6–4.5). In addition, 20% of patients decreased medication dosage, whereas 30% increased it.
These preliminary results suggest that this transdermal analgesic is efficacious in reducing opioid use and pain scores in patients experiencing chronic neuropathy and musculoskeletal pain. In addition, overall patient satisfaction was high and adverse effects were scarce.
This study was funded by Annie's Apothecary, Kerrville, TX and Boerne, TX; Boothwyn Pharmacy, Boothwyn, PA; and Cypress Compounding Pharmacy, Houston, TX.
J. Gudin: Honoraria paid by Clarity Research and Consulting, LLC; E. Harris: Consultant to Clarity Research and Consulting, LLC; M. Brennan: Honoraria paid by Clarity Research and Consulting, LLC; P. Hurwitz: Study funded by the 4 pharmacies listed above. D. Dietze: Analysis paid by Clarity Research and Consulting, LLC.
- Gudin J, Harris E, Brennan B, Hurwitz P, Dietze D. Decreased opioid use and pain scores after 5 months therapy with a compounded topical/transdermal analgesic: fourth interim and preliminary control group results from the Optimizing Patient Experience and Response to Topical Analgesics (OPERA) observational study. Presented at: AAPM 2016. San Antonio, TX; September 21-25, 2016.
- Poquet N, Lin C. The Brief Pain Inventory (BPI). J Physiother. 2016;62(1):52. doi: 0.1016/j.jphys.2015.07.001.