Topical Creams for Localized Chronic Pain—Do They Really Work?

Prescription topical pain preparations can cost from $20 to thousands of dollars and are often perceived as a safer treatment approach that is free of the side effects or addictive potential of other pain medications. In 2015, Medicare Part D spent over $500 million in coverage for the prescriptions. But a carefully designed study that was mandated by congress and conducted by researchers from Johns Hopkins Medicine and Walter Reed National Military Medical Center has concluded that these compounded preparations provide no statistically significant advantage in pain relief when compared to placebo. Senior author Steven Cohen, MD, director of pain research at Walter Reed and professor at the Johns Hopkins University School of Medicine, summarized, “Our study of nearly 400 pain patients suggests that people who use these compounded creams and gels are being taken advantage of, because the scientific evidence to support a benefit is not there.” The results were published earlier this week in Annals of Internal Medicine.

The double blind, randomized, placebo controlled study was conducted at Walter Reed from 2015 to 2018, and engaged 399 participants aged 18 to 90 and 51% female. Study subjects had localized pain in the face, back, buttocks, neck, abdomen, chest, groin, and/or extremities with an average duration of 6.7 years. They were further categorized by pain causality, either neuropathic, injury to tissue, or mixed origin. Each category was randomized to receive either a compounded topical preparation or placebo for application 3x daily. Pain score reports were compared, and no statistically significant difference was found between mean reduction in scores between the 2 groups in any of the 3 categories. Dr. Cohen remarked, “With the number of research participants studied as long as they were studied, we should have been able to see a statistically significant difference in pain reduction if these creams were actually working. But we didn’t see this in our data.”

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Read about the study conclusions.

The journal abstract may be read here.