Chronic pain: compounded creams no better than placebo

  • Brutcher RE & al.
  • Ann Intern Med
  • 5 Feb 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Compounded topical pain creams offer no more relief than placebo for neuropathic, nociceptive, and mixed localized chronic pain.

Why this matters

  • Compounded pain creams are expensive and, unlike single agents such as NSAIDs and lidocaine, are not approved or regulated by the FDA.

Study design

  • Double-blind, randomized, parallel study of 399 patients with neuropathic (n=133), nociceptive (n=133), or mixed (n=133) localized chronic pain.
  • Patients were randomly assigned to receive either specially formulated compounded pain cream for each pain type or placebo.
  • Funding: Centers for Rehabilitation Sciences Research, Defense Health Agency, US Department of Defense.

Key results

  • Follow-up time, 1 month.
  • Mean reduction in average pain scores was not significantly different between compounded pain cream vs placebo (mean difference [MD], −0.3; 95% CI, −0.6 to 0.1 points).
    • Neuropathic pain: (MD, −0.1; 95% CI, −0.8 to 0.5 points).
    • Nociceptive pain: (MD, −0.3; 95% CI, −0.9 to 0.2 points).
    • Mixed pain (MD, −0.3; 95% CI, −0.9 to 0.2 points).
  • Patients reported positive outcome (MD, 8%; 95% CI, −1% to 17%) and positive satisfaction (MD, 5%; 95% CI, −5% to 14%) were not statistically different between groups at 1 month.

Limitations

  • Short follow-up.

Coauthored with Antara Ghosh, PhD

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