Half of Chronic Pain Patients Halt Opioids With Topical Analgesic

Jeffrey Gudin, MD

A new study suggests topical analgesics could be an important part of the solution to the ongoing opioid addiction crisis.

The research firm Clarity Science found that nearly half of patients given a topical analgesic after taking opioid painkillers had quit taking opioids within 6 months. In addition, 3 in 10 patients said they were no longer taking any pain medication at all.

Jeffrey Gudin, MD, the lead investigator on the study, said the results are a welcome confirmation of what he’s seen in the clinic.

“The results were indeed a pleasant surprise,” he told MD Magazine. “As a practicing pain management specialist, I can tell you the topical analgesics at least can minimize opioid requirements, but at best we see results similar to the study whereby patients can discontinue opioids completely.”

The study is based on a subset of patients in the recent Optimizing Patient Experience and Response to Topical Analgesics (OPERA) Study. The subset patients had been taking opioids for chronic pain at the start of the study, and then [they] were prescribed a topical analgesic to help with the pain. Patients were re-assessed at 3 months and 6 months.

A total of 121 patients completed the baseline assessment and the 3-month follow-up. Of those, 49% had stopped using opioids by the follow-up, and 31% had discontinued all use of pain medications. Concurrent medication use dropped by 65% in the group.

Of the 27 patients in the 6-month follow-up group, 56% had stopped opioid use by the 6-month check-in, 30% had stopped pain medications altogether, and concurrent medication use dropped by 74%.

Both cohorts also reported statistically significant reductions in pain severity, and side effects from the topical analgesics were minimal and reported by less than 2% of patients.

Clarity president Peter Hurwitz, said in a statement that he hopes the study helps sway insurers and others to the benefits of topical medications.

“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,” Hurwitz said. “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. Of course, one other challenge may be convincing patients that they can trust a topical analgesic.”

Gudin, who is also pain and palliative care at Englewood Hospital, in New Jersey, said he sometimes gets pushback from patients when he suggests a topical analgesic, but he’s able to change minds with some explanation.

“I simply explain to them that the most common prescription requested by patients in my practice is a local anesthetic (prescription lidocaine) patch that goes directly over the site of pain,” he said. “I also don’t eliminate their pharmacotherapy when prescribing topical analgesics, but wait for pain relief to occur, and then slowly taper their medication regimen.”

Gudin also noted that the targeted nature of topical analgesics results in minimal systemic absorption, which can further lower adverse effects.

The study, “Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: an exploratory analysis,” was published in Postgraduate Medicine.