Jenny L. F. Andrus, MD
We have all heard about the Opioid Epidemic in the United States, The abuse or overuse of opioids is the reason for the deaths of over 50,000 people in 2019. Clinicians and politicians alike are trying to tackle this issue in order to prevent more deaths in the future. New, strict guidelines have been issued regarding opioid use and physicians who prescribe opioids can be held liable if they fail to properly follow them.
Yet, acute or chronic pain is a huge problem which affects around 100 million people or one out of three persons in the US. Every day, people are injured in work accidents, sports or car crashes, stricken with painful health conditions or have surgeries which cause lasting discomfort. How do physicians effectively and safely treat patients who have severe pain while being mindful of the scary statistics that indicate continued opioid use is a danger?
A new study, published by Clarity Science, a division of Safe Harbor Compliance and Clinical Services LLC, found that when a topical (patch, cream or gel rubbed onto the skin over the painful area) analgesic was prescribed, along with an opioid for pain control, 50% of those patients were able to discontinue the use of the opioid during a post-treatment period of three to six months. The research was published in the Journal of Postgraduate Medicine under the title Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: an exploratory analysis.
In the study, 121 chronic pain patients who took opioids were followed for 3 months. Only 27 of the patients however were still participating in the study at 6 months. They were given topical analgesics to use concurrently. The data was measured by administering three surveys to the patient. The surveys measured patients before using the topical analgesic, 45 days after usage of the topical analgesic began and 90 days after starting usage of the topical pain reliever. Minimal side effects from the topical analgesics were only reported by 2%, but the significant findings were that 50% were able to discontinue the use of opioids in a 3-6 month period, 30% stopped taking any pain medication and the group saw statistically significant decreases in both pain severity and interference scores. While further larger studies are needed, this research shows great promise.
When I mention topical analgesics, I am not talking about Ben-Gay, Aspra-crème, Capsaicin, Salon-pas or Absorbine, Jr. Those are muscle rubs or patches which certainly have their place in relieving muscle pain. However, these are not the pain creams available by prescription we are talking about in this study. As an Interventional Pain Management physician, I commonly prescribe topical analgesics for my patients. There are many which are mass produced and made available by prescription. Voltaren Gel or Flector Patch are well-known examples.
Sometimes, I order special topical ointments from a Compounding Pharmacy. The pharmacist there will create a blended mix of medications that can treat the needs of specific pain patients. These medications can include lidocaine, muscle relaxers, anti-inflammatories, anti-hypertensives, and neuropathic pain medications. This pain cream “cocktail” of medications works together to help relieve severe pain when rubbed into the skin over the painful area. It is also important to note that topicals can be used without many of the side-effects of oral or injected medications, such as stomach upset or sleepiness. A drawback of compound pain creams is that they can be very expensive, even with insurance coverage.
I work with my patients to find the safest, most cost-effective method of managing their pain and topical analgesics help me to do that, sometimes with and sometimes without the concurrent use of opioids.