Topical Analgesics Cut Opioid Use 50% – New Study
Biloine W. Young • Tue, January 2nd, 2018
I well remember a conversation I had with a physician friend many years ago. Our topic was pain experienced by patients and my doctor friend was defending the use of opioids.
“They are a gift from God,” he declared emphatically, his attitude reflecting the thinking of the 1970s.
No one wants to live with daily pain with the result that there were over 50,000 drug overdose deaths in 2016, all attributed to the improper use of opioids.
Approximately 100 million patients deal with pain and are the candidates for opioid prescriptions. Once patients have started on opioid treatment for five days, they are at risk for continuing these medications long-term.
Furthermore, they are not likely to discontinue opioids after they have received them for 90 days, according to studies carried out by Clarity Science, a division of Safe Harbor Compliance and Clinical Services LLC.
50% Stop Using Opioids
A Charity Science study found that about 50% of patients taking opioids together with prescribed topical analgesics for their pain discontinued use of their opioid medication after a three or six-month period of treatment.
The results are published in the Journal of Postgraduate Medicine in a study titled “Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: an exploratory analysis.” Long-term use of opioids can lead to physical dependence with increased doses needed to achieve optimal pain control.
According to the study results, “a subset of 121 chronic pain patients who were taking opioids at study enrollment showed that after treatment with topical analgesics, 49% of patients in the 3-month and 56% of patients in the 6-month group reported they had completely discontinued use of opioids.”
“In addition, 30% of patients reported that they were no longer taking any pain medication. Concurrent medications decreased by 65% after 3 months, and 74% after 6 months and there were statistically significant decreases in pain severity and interference scores within both groups. Lastly, less than 2% of patients reported minimal side effects associated with the topical medication.”
According to Jeffrey A. Gudin, M.D., the lead investigator of the study and the Director of Pain and Palliative Care at Englewood Hospital in New Jersey, "In addition to previous results showing that topical analgesics were associated with reductions of up to 60% in the use of concurrent pain medications, including oral opioid analgesics, we now have data reflecting discontinuation of opioids after being treated with this therapy for 3- and 6-months.”
“Especially in today's environment, identifying treatments other than opioids for clinicians to prescribe to their pain patients has become a priority."
The study is an ongoing observational survey study looking at patients (ages 18-64) with chronic musculoskeletal and neuropathic pain who subsequently were prescribed topical analgesics. A total of 417 patients had been prescribed some form of topical drug, including:
- Flurbiprofen (20%)
- Amitriptyline (5%)
- Magnesium Chloride (10%)
- Gabapentin (6%)
- Bupivicaine (2%)
- Other transdermal gel
Patients completed three surveys during the study, all at different points in the treatment:
- Survey 1: First patient visit before using the topical agent
- Survey 2: Second patient visit approximately 45 days later
- Survey 3: Third patient visit approximately 90 days later
National Academies of Science, Engineering and Medicine Weigh In
In July 2017, the National Academies of Science, Engineering, and Medicine (NASEM) reviewed the history and role of opioids to identify actions that clinicians can take to respond to the opioid epidemic.
They found that research on pain was poorly resourced and suggested that it include studies that emphasize available treatment. They recommended that public and private payers develop reimbursement models for comprehensive pain management that increase coverage to encompass these alternative pharmacologic and non-pharmacologic approaches.
Clarity President and an author of the study Peter Hurwitz notes, "We hope the results of this study empower the payers to re-evaluate how they address coverage of treatments for their patients experiencing chronic pain.”
“We have heard in the past that there is not sufficient scientific evidence supporting the use of topical analgesics for the management of chronic pain. With the focus on reducing the number of patients being prescribed opioids, other available therapeutic options must be considered to allow their patient-members in pain to be properly treated and managed. The results of this study are a positive step in that direction."