Although the use of costly topical pain relief creams has been increasing over the years, a recent clinical trial evaluated how well they actually relieve pain compared to placebo cream.
People use pain relief creams for a variety of conditions, including flair ups from arthritis, gout, muscle pain, bursitis, and tendonitis. Although pain relief creams are commonly used, there is mixed research on how effective they really are. A scientific review from 2016 found that some prescription topical NSAIDs, particularly those containing diclofenac or ketoprofen, provide the same pain relief as oral medications for specific types of pain. However, several other studies have not demonstrated that these creams actually relieve pain.
In addition, some creams such as those containing capsaicin do relieve pain but only after using them for a long period of time. Since pain relief creams are medications, there is still a need to evaluate risks, including interactions with other medications in addition to side effects such as skin irritation, strong odors, and burning sensations.
A recent study published in Annals of Internal Medicine sought to figure out if compounded pain creams were better at alleviating localized pain than placebo creams. Researchers from Walter Reed National Military Medical Center in the United States enrolled 399 patients with localized pain of the following characteristics: 133 patients with pain from nerve damage, 133 patients with pain from non-nerve tissue injury, and 133 patients with both types of pain to receive either a pain relief cream compounded for their type of pain or a placebo cream.
The pain relief creams compounded for neuropathic pain were composed of ketamine, gabapentin, clonidine, and lidocaine; creams compounded for nociceptive pain included ketoprofen, baclofen, cyclobenzaprine, and lidocaine; and creams compounded for both types of pain included ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine.
Using pain scores to measure pain relief
The researchers primarily looked at patients’ self-reported responses to pain scores one month after receiving either the pain relief cream or placebo treatment. A positive response was indicated by a reduction in their pain score of two or more points along with a score above three on a five-point satisfaction scale and other responses to health survey scores. Patients who had a positive outcome were followed through for three months.
Although using self-reported responses is challenging to quantify and the follow-up period was only one month, the study was able to retain patients and accurately compare their responses at follow-up with what they had originally responded. Therefore, the main limitations to this study included the number of participants, which is relatively small given a large number of people who suffer from chronic pain (31% of the population), as well as the classification of pain because there are other types of pain besides neuropathic and nociceptive.
No differences in pain scores between pain relief cream and placebo cream
There were no differences found in the average pain scores between patients who used a pain relief cream and those who used a placebo cream. After one month, 72 (36%) patients who used a pain relief cream and 54 (28%) patients who used a placebo cream had a positive outcome, i.e. pain relief. As such, compounded pain relief creams were not found to improve pain scores, functional improvement, or satisfaction significantly more than placebo creams, despite their higher costs and increased usage.
Furthermore, there were a very small number of patients who had a positive outcome after three months of follow up compared to patients who had a positive outcome after one month of follow up in all of the pain relief cream as well as the placebo cream group.
Written by Tatsiana Verstak, M.S., B.S.
- Brutcher, R.E. et al. Compounded Topical Pain Creams to Treat Localized Chronic Pain: A Randomized Controlled Trial. Annals of Internal Medicine. Epub 5 February 2019.
- Derry S, Conaghan P, Da Silva JP, Wiffen PJ, Moore R. Topical nonsteroidal anti-inflammatory drugs for chronic musculoskeletal pain in adults. Published 22 April 2016.
- Pain Pathways. Do Pain Creams Really Work? Pain Pathways Magazine. Published 12 July 2018.