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.
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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