Tuesday, 25 Feb 2020

You are here

Compounded Pain Creams - Expensive Placebos?

The Annals of Internal Medicine reports that the growth and use of compounded pain creams is unwarranted as they were no better than placebo in a randomized controlled trial, suggesting their higher costs are unjustifiable compared to other topical commercially available agents (lidocaine, diclofenac, capsaicin, etc.). (Citation source: https://buff.ly/2BkTj58)

Compounded pain cream use has grown substantially in the last few  years.  These custom-blended agents use a concoction of commonly used drugs.  Compounded pain creams differ when used 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).

Researchers studied 399 patients with different types of chronic pain to receive either a compounded cream containing an analgesic or a placebo.

For the primary outcome, no differences were found in the mean reduction in average pain scores between the treatment and placebo patients with either neuropathic pain, nociceptive pain, or mixed pain.

After 1 month, a positive outcome was seen in 36% on the pain cream and 28% on the placebo cream (not significant).

The investigators noted that a limitation of the study is patients may have already tried conventional pain relievers without success, increasing the likelihood that compounded pain creams would also be ineffective.

They surmised that compounded pain creams were not better than placebo and their higher costs compared with approved compounds should curtail routine use.

 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Half of Opioids Rx Come from 1% of MDs

The BMJ reports that while most US providers are cautious in their prescribing, half of opioid prescriptions are written by 1% of providers.

Between 2003 and 2017, there was an annual average of 669495 providers prescribing 8.9 million opioid prescriptions.

In 2017, 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions; that's nearly 1000 times more than the middle 1% of prescribers.

Domestic Abuse Linked to Fibromyalgia and Chronic Fatigue

Domestic violence was found to predispose to a higher risk of fibromyalgia and those developing chronic fatigue syndrome.

Researchers studied the association between intimate partner violence (IPV) with fibromyalgia and CFS, using a retrospective open cohort design of patients entered into the “The Heath Improvement Network” database between 1995 and 2017.

A Potential Biomarker for Chronic Fatigue Syndrome Patients

Myalgic encephalomyelitis/chronic fatigue syndrome affects at least 2 million people in the United States and bears tremendous overlap with fibromyalgia - both being difficult to diagnosis because the symptom complex is often unrecognized and these conditions have no biomarker test. 

NIH Conference Review of Chronic Fatigue Syndrome

The current issue of JAMA reviews recent advances on chronic fatigue syndrome, also known as myalgic encephalomyelitis/(ME/CFS), based on a 2-day conference held at the NIH in an April 2019. The NIH 2-day conference reviewed recent progress and new research in several areas described below.

Study Looks at Opioid Use After Knee Surgery

A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.