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Topical analgesics safe, effective for chronic pain
Topical analgesics were safe and effective for the relief of certain types of moderately severe chronic pain, according to a review of OPERA study findings published in the Journal of Pain Research.
“Opioids and other controlled substances prescribed for chronic pain are associated with abuse, addiction and death, prompting national initiatives to identify safe and effective pain management strategies including topical analgesics,” Jeffrey A. Gudin, MD, director of pain and palliative care at Englewood Hospital and Medical Center, Englewood N.J., and colleagues wrote.
According to background, the prospective, nonrandomized OPERA study assessed changes from baseline in overall mean severity and interference scores on the Brief Pain Inventory scale among patients with chronic pain treated with topical analgesics.
Gudin and colleagues recorded the use of concurrent pain medications at 3- and 6-month follow-up assessments. Patients were treated with either a topical patch or cream and had insurance that covered the treatment. Researchers compared changes in pain severity, medication usage and interference between treated patients and matched and unmatched controls.
Overall, 631 patients (mean age, 46.3 years) completed both baseline and 3-month follow-up surveys and 158 patients (mean age, 46.8 years) completed both baseline and 6-month follow-up surveys.
At 3 months, 53.6% of patients in the unmatched intervention group vs. 4% in the unmatched control group reported de-escalation in the simultaneous use of medications, whereas at 6 months, the rate was 60% in patients in the unmatched intervention group vs. 5.9% in the unmatched control group (P for both < .001). In addition, 10% of the unmatched intervention group demonstrated an increase in medication usage compared with 52% in the unmatched control group.
Furthermore, the overall mean pain interference and severity scores within the unmatched intervention group decreased from baseline for both the 3- and 6-month groups compared with the unmatched control group (P for all < .001). In the 3-month unmatched-intervention group, the overall mean pain severity dropped from 4.8 to 3.3, and a similar drop was reported in this group’s overall mean pain interference score.
E. Dennis Harris, MD, chief medical officer, Clarity Science, Austin, and study researcher discussed the implications of the findings in a press release.
“Existing topical analgesics that have lost big pharma interest have been found not only to have a profound therapeutic effect, but also offer a safe and effective alternative to opioids,” he said in the release. “The study demonstrates a measurable improvement in quality of life. New and experimental drugs are not always the answer to current issues; even with generic combinations, we can immediately address such monumental issues such as the current opioid epidemic.” – by Janel Miller
Disclosures: Gudin reports receiving compensation from Clarity Science for his role as co-principal investigator and for providing protocol-required services for the study. Harris reports being an employee of Clarity Science. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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There is a terrific need for analgesic therapy that is safe and effective without the risks for misuse and abuse, side effects and accidental overdose that are intrinsic to opioid therapy. In addition, many patients have intolerance or medical contraindication to NSAID therapy. A number of studies have found that topical NSAID therapy can be an effective component of pain management for a variety of conditions. The authors of the OPERA study provide a more real-world evaluation of the use of topical agents for a variety of common pain conditions and also to extend the follow-up to as long as 6 months.
The authors chose a convenience sample of patients and chose not to standardize the intervention, randomize patients to treatment or control, or provide any blinding. In short, the patients who received treatment were aware that they were being treated and knew what they were being treated with while the few control patients were aware that they were not being treated. These choices certainly hinder our confidence in the validity of the results, although the authors are clear in pointing out the need for randomized controlled trials to confirm their findings.
I don't think readers can take away from this paper a compelling argument to initiate topical analgesic therapy. This review of the differences between baseline and follow-up pain, other medication use, and reported interference with activities, serves to remind clinicians that topical therapies may play an important role in the management of chronic pain and warrant further review. Some of these topical treatments are readily available in commercial and compounding pharmacies and may be covered by commercial insurance, Medicaid plans and Medicare Part D plans.
Individuals who are at risk for adverse effects or are unable to tolerate oral NSAID therapy might do well to try a topical therapy instead of or in addition to other, better-proven pain management strategies, including physical therapy, chiropractic manipulation, cognitive behavioral therapy or exercise. Topical analgesic therapy might also be used as a strategy for reducing the dose of chronic opioid therapy. Clinicians should remain on the lookout for more rigorous research regarding topical analgesics.