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(Reuters Health) – According to a US study, compound pain relief creams are no better at treating chronic pain than topical treatments containing no drugs.
Pharmacists prepare bespoke medications to give patients a different dose or formulation than they can get with mbad-produced prescription drugs. The current study focuses on pain creams manufactured from drugs often prescribed for pain relief, such as muscle relaxants, anticonvulsants and nonsteroidal anti-inflammatory drugs (NSAIDs).
The researchers randomly badigned 399 patients with different types of chronic pain to receive a combination cream containing an badgesic or a placebo cream without any medication.
After one month, 36% of patients who used pain creams and 28% who received placebo reported less pain than at first, a difference too small to rule out the possibility that it was due to chance.
"We have learned from other studies that some of the agents (lidocaine, nonsteroidal anti-inflammatory drugs) may be effective against certain types of acute and chronic pain, so it is surprising that the difference did not reach statistical significance in any of the case. types of pain, "said Dr. Steven Cohen, lead author of the study, researcher in the field of pain at the Walter Reed National Military Medical Center in Bethesda, Maryland and Johns Hopkins Medicine in Baltimore.
"It's important because compound pain relief creams are much more expensive than painkillers prescribed (lidocaine, diclofenac) or over-the-counter (capsaicin), but they do not provide any significant benefit over placebo cream," he said. said Cohen by email.
All patients in this study were treated in pain treatment clinics at Walter Reed and presented with one of three types of pain syndromes. Within these three groups, patients were randomly selected to receive either a compound cream or a placebo cream.
One-third of patients had neuropathic pain, due to nerve damage and phantom pain experienced by amputees. Patients in this group who received compound creams received anticonvulsants.
Another third suffered from a so-called nociceptive pain, the most common type that is often due to an injury or infection, and not to nerve damage. Patients in this group who received compound creams received muscle relaxants and NSAIDs.
And a third had a "mixed" pain caused by a variety of things; many of the compound creams were similar to drugs administered for nerve damage or nociceptive pain.
None of the patients reported serious side effects of the treatment that had been badigned to them, but a greater number of them experienced skin irritation, rashes, and redness with compound pain creams that with placebo creams: 7% compared to 2%.
When patients rated their pain levels on a 10-point scale, with 10 being the most painful, the average pain reductions reported by users of compound cream and the placebo group after one month were almost identical. The difference between groups was 0.1 points for neuropathic pain and 0.3 points for nociceptive and mixed pain.
One of the drawbacks of the study is that many participants have tried unsuccessfully conventional painkillers, which increases the likelihood that compound painkillers will also be ineffective, say the researchers in Annals of Internal Medicine.
The authors also pointed out that the study may have had too few patients to detect subtle but clinically significant differences between compound pain creams and placebo.
Nevertheless, the study tested the drug combinations most frequently used in antidepressant creams and found them devoid of three different types of pain, said Dr. Nebojsa Nick Knezevic, pain researcher at Advocate Illinois Masonic Medical Center from Chicago, not involved. in the study.
"This does not mean that we should abandon the use of topical badgesics for different types of localized pain because it is safer and easier to use than systemic medications, especially in elderly patients with severe pain. Other (complex chronic medical problems), "said Knezevic. E-mail.
"However, more randomized placebo-controlled trials are needed with a different combination of drugs before they are used in daily practice," Knezevic added.
SOURCE: Annals of Internal Medicine bit.ly/2G8fNud, online February 4, 2019.
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