Can a topical analgesic replace opioids for pain?

The opioid epidemic continues to rage across the U.S., pain-treatment alternatives such as a topical analgesic are receiving research support

These days it’s impossible to browse the internet without realizing that America is suffering from an ongoing health care crisis involving chronic pain and its treatment with prescription opioids. The unfortunate truth is that a staggering number of Americans live with debilitating chronic pain. Furthermore, patients are at high risk of addiction or death from overdose. Given all of these contra-indications, it would certainly make sense to explore other treatment avenues for chronic pain such as a topical analgesic.

Over the past decade, there has been some exciting research taking place on the use of a topical analgesic to potentially replace the use of opioids for some patients. How might topical analgesics benefit your patients who are struggling with chronic pain?

Chronic pain and the opioid crisis

According to a 2015 study that examined a nationwide survey of the health status of Americans, more than 125 million adults reported experiencing pain during the previous three months (a common metric used for determining chronic versus acute pain).¹ Of those with chronic pain, approximately 11% (more than 25 million) reported daily pain over the course of three months. Furthermore, more than 23 million people (approximately 10%) reported that they experienced severe pain.¹

Statistics regarding deaths and substance abuse related to opioids are equally grim. According to both the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), almost 47,000 Americans died in 2018 as a result of opioid overdose, including prescription opioids. In that same year, almost 2 million Americans suffered from substance abuse related to prescription opioids for pain relief.^2,3

Topical analgesic for pain: the research

A 2017 article in the Journal of Pain Research examined the effect of topical analgesics on pain severity, interference and standard pain medication usage, over the course of either three or six months.⁴ The three- and six-month topical analgesic treatment groups both showed statistically significant decreases in pain severity and interference, compared to a control group. Furthermore, a higher percentage of both the three- and six-month groups used less standard pain medications, while a higher percentage of the control group used more medication. The researchers concluded, “Topical analgesics appear to be effective and safe for the treatment of chronic pain, with randomized controlled trials needed to confirm these findings.”⁴

In a follow-up paper, published in the journal Postgraduate Medicine, the same group of researchers used a subset (n = 121) of the patients from the earlier study to determine if treatment of pain with topical analgesics might reduce or stop use of opioids.⁵ At the three-month point, 49% of patients reported they were no longer using opioids. This percentage increased to 56% by the six-month point. Furthermore, 31% of the patients at the three-month follow-up point, and 31% at six months, reported no longer using any pain medications, including opioids.

The researchers concluded: “Opioid use and other concurrent medications decreased among opioid-experienced chronic pain patients after three and six months of treatment with topical analgesics. Pain severity and interference scores also decreased. The topical analgesics were reported to be effective and safe for the treatment of chronic pain, with randomized controlled trials needed to confirm these findings.”⁵

Chronic pain patients face a double-edged sword. They come to you seeking relief from pain, but also for treatment that does not carry the same risks as opioids. Fortunately, a topical analgesic may be able to address both needs for some of these patients.

References

1. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. Journal of Pain. 2015;16(8):769-780.
2. CDC Centers for Disease Control and Prevention. Prescription Opioid Overdose Data. Updated March 2020.
3. National Institute on Drug Abuse. Opioid Overdose Crisis. Updated April 2020.
4. Gudin JA, Brennan MJ, Harris ED, et al. Changes in pain and concurrent pain medication use following compounded topical analgesic treatment for chronic pain: 3- and 6-month follow-up results from the prospective, observational Optimizing Patient Experience and Response to Topical Analgesics study. Journal of Pain Research. 2017;10:2341‐2354.
5. Gudin JA, Brennan MJ, Harris ED, et al. Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: An exploratory analysis. Postgraduate Medicine. 2018;130(1):42‐51.