A study from researchers at Johns Hopkins Medicine and Walter Reed National Military Medical Center was published in the February 5th issue of the “Annals of Internal Medicine”. It focused on topical pain creams or gels and whether they had an impact on treating localized chronic pain.
The researchers set out to look at compounded pain creams, which are presented as an alternative to opioids, but can be expensive. They typically include one or more prescription or other anesthetic, analgesic, sedative, antidepressant, anti-seizure or muscle relaxant drugs that can be used to treat pain.
Subjects were aged 18-90 and almost half were active duty military personnel. The other participants in the study were retired or dependents, such as spouses. Over half were female, and all were patients at military treatment facilities. Researchers looked at 399 patients with localized pain (pain in one area of the body) whose pain was neuropathic (caused by nerve damage), nociceptive (caused by an injury) or mixed pain. Subjects were divided into groups and given a placebo or a cream with an ingredient aimed at treating their specific kind of pain. They followed patients for one month and then followed those who reported improvements for another two months, three months in total after they began their treatment.
They found no meaningful difference in outcomes between patients using the placebo and those using compounded creams. All participants improved slightly throughout the study, which may be attributed to the placebo effect. In the neuropathic pain group there was a 0.1-point difference in reported pain scores between the drug and placebo groups. In the mixed pain group there was a 0.3-point difference between the drug and placebo groups.
The senior author of the paper, Steven P. Cohen, M.D., says that given the number of patients they followed and for the length of time that they were followed, they should have been able to see a statistically significant difference in pain reduction if the creams were working. He did caution that there were limitations on this study because of the wide variety of medical conditions and pain disorders that affected the study group. He said they could not use a common ingredient, capsaicin, because the smell would have given it away and ruined the double-blind process they used.
The study’s conclusion was that these creams might not be worthwhile, given their cost and their relatively minor benefits.
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