Don’t rub it in – compounded pain creams fail to deliver

The use of individually compounded creams as a topical treatment for chronic pain has increased in popularity, perhaps in part because of a lack of effective options for pain management and also the toxicity profile of drugs prescribed by the oral route for this purpose.  A recent study involved 399 patients with localized pain classified by each patient’s treating physician as neuropathic (n = 133), nociceptive (n = 133), or mixed (n = 133). Pain creams compounded for neuropathic pain (containign ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), were prescribed and compared to placebo. 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. No differences were found in the mean reduction in average pain scores between the treatment and control groups for patients in any sub-group, or indeed for all patients with pain considered as a single group. After one month, 36% in the treatment groups and 28% in the control group had a positive outcome (risk difference, 8% [CI, −1% to 17%]). Compounded pain creams did not outperform placebo formulations – a disappointing outcome, the search for effective treatment options continues. View the original study here