Brutcher RE, Kurihara C, Bicket MC, et al. Compounded Topical Pain Creams to Treat Localized Chronic Pain: A Randomized Controlled Trial. Ann Intern Med. 2019 Feb 5. pii: 2724041. doi: 10.7326/M18-2736. (Original study)

Background: The use of compounded topical pain creams has increased dramatically, yet their effectiveness has not been well evaluated.

Objective: To determine the efficacy of compounded creams for chronic pain.

Design: Randomized controlled trials of 3 interventions. ( NCT02497066).

Setting: Military treatment facility.

Participants: 399 patients with localized pain classified by each patient's treating physician as neuropathic (n = 133), nociceptive (n = 133), or mixed (n = 133).

Interventions: Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo.

Measurements: The primary outcome measure was average pain score 1 month after treatment. 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. Secondary outcomes included Short Form-36 Health Survey scores, satisfaction, and categorical response. Participants with a positive outcome were followed through 3 months.

Results: For the primary outcome, no differences were found in the mean reduction in average pain scores between the treatment and control groups for patients with 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]), or mixed pain (-0.3 points [CI, -0.9 to 0.2 points]), or for all patients (-0.3 points [CI, -0.6 to 0.1 points]). At 1 month, 72 participants (36%) in the treatment groups and 54 (28%) in the control group had a positive outcome (risk difference, 8% [CI, -1% to 17%]).

Limitations: Generalizability is limited by heterogeneity among pain conditions and formulations of the study interventions. Randomized follow-up was only 1 month.

Conclusion: Compounded pain creams were not better than placebo creams, and their higher costs compared with approved compounds should curtail routine use.

Primary Funding Source: Centers for Rehabilitation Sciences Research, Defense Health Agency, U.S. Department of Defense.

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Comments from MORE raters

Physician rater

Not sure this is news.

Physician rater

These creams are very commonly used, for sure, and I don't know the literature in this field, but I suspect it will be news to most primary care physicians that they are no better than placebo.

Physician rater

A very important study for primary care physicians who deal with a large number of elderly patients with chronic pain. Physicians are constantly looking for alternatives to NSAIDs and opioids for managing pain. This study is disappointing in that it casts negative light on a previously promising method for managing pain. More studies are needed.

Physician rater

Compounded pain creams are a very specialized area.

Physician rater

Seems to have been a well done study, even with the stated limitations. Disappointing but not surprising results to those of us who have tried to treat patients with these therapies.

Physician rater

I don't have the opportunity to prescribe compounded creams for pain, but the premise of the article makes sense to me.

Physician rater

Somewhat counterintuitive, but such is science. Would like to eventually see a similar study for compounded nausea gels.
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