The use of compounded topical pain creams does not appear to benefit patients with chronic pain when compared with placebo creams, according to a study published in Annals of Internal Medicine.

To investigate the effectiveness of compounded creams in the treatment of localized chronic pain, study authors performed a double-blind, randomized, parallel study comparing creams compounded with an active ingredient to placebo creams. Patients (N=399) were divided into 3 chronic pain groups and were treated with either a specific pain cream formulation or placebo cream: neuropathic pain (N=133; cream: ketamine 10%, gabapentin 6%, clonidine 0.2% and lidocaine 2%), nociceptive pain (N=133; cream: ketoprofen 10%, baclofen 2%, cyclobenzaprine 2%, and lidocaine 2%), and mixed pain (N=133; cream: ketamine 10%, gabapentin 6%, diclofenac 3%, baclofen 2%, cyclobenzaprine 2%, and lidocaine 2%); creams were applied 3 times per day to the affected areas.

Average pain score (0-10 numerical scale) 1 month after starting treatment was designated as the primary outcome. “A positive categorical response was a reduction in pain score of 2 or more points coupled with a score above 3 on a 5-point satisfaction scale,” the authors explained.

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Results showed that among all the pain groups, no difference was observed between the treatment group and placebo group in the mean reduction in average pain scores at 1 month (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]; mixed pain: -0.3 points [CI, -0.9 to 0.2 points]; all patients combined: -0.3 points [CI, -0.6 to 0.1 points]). In addition, rates of satisfaction and positive outcome (secondary outcomes measured by the Short Form-36 Health Survey score) were found to be similar between the treatment group (43% and 36%, respectively) and placebo group (38% and 28%, respectively).

“We found that specially formulated compounded pain creams provided little benefit in our study participants, more than 40% of whom were active-duty personnel,” the authors reported. “Considering the increased costs of using a non-FDA-approved and regulated compounded cream rather than a single agent, we caution against routine use of compounded creams for chronic pain.”

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