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Topical Analgesics May Reduce or Eliminate Prescribed Opioid Use

December 15, 2017
Approximately half of the patients discontinued their need for opioids entirely between three and six months, and another 30% were able to transition off all pain medication during that time, according to OPERA study authors

With Jeffrey Gudin, MD, and John Claude Krusz, PhD, MD 

Topical analgesia, given to opioid-experienced chronic pain patients, reduced or eliminated the need for opioids, with more than half discontinuing the need for them entirely,1 published in Clinical Focus: Pain Management Fast Track.

"The findings were certainly surprising to us," said Jeffrey Gudin, MD, director of pain management and palliative care at Englewood Hospital and Medical Center in New Jersey, who led the study, ''As a clinician active in the pain world, I have seen it [discontinuation of opioids] but certainly not at this magnitude."

Some patients were able to stop their opioids after using topical analgesics.

The difference may be attributed to the encouragement given to the patients; he said, "We put them in the mindset of tapering off the opioids.”

In this three-month assessment,1 Dr. Gudin and his colleague broke out a subset of patients from their prospective, observational study, Optimizing patients experience and response to topical analgesics (OPERA).2 The researchers concluded that topical analgesics provided a safe and effective treatment alternative to both prescription opioids and non-steroidal anti-inflammatory drugs (NSAIDs) for the management of some chronic pain conditions.2

Patients were seeking treatment for pain including neuropathy, arthritis, radiculopathy, myofascial, musculoskeletal and tendinitis, all of which was considered of moderate severity.1 In OPERA, the researchers followed 631 patients and found more than half de-escalated the use of concurrent pain medicines.

A Closer Look at the Treatment Progress of Pain Patients 

In the subgroup analysis, the researchers followed 121 patients who completed baseline and three-month follow up assessments.1 Of those, 27 opioid-experienced patients also completed six-month follow-up assessments.

After treatment with topical analgesics, 49% of those in the three-month group and 56% of those in the six-month group reported they had discontinued any use of opioids completely.1 Another 31% of the patients at three months and 30% at six months, said they were no longer taking any other pain medications. Other concurrent pain medication use declined by 65% at three months and 74% at six months.

Pain severity and inference scores were statistically significant within the three-month group (CI: 0.7-1.4, 1.4-2.2) and the six-month cohort (CI:0.7-2.4 severity) CI 1.2-3.5 (inference) opioid-experienced groups.1 At baseline, patients were on prescription opioids or opioids in combination with prescription NSAIDs or over-the-counter pain relievers. The topical analgesics prescribed to participants included diclofenac, ketoprofen, and flurbiprofen.

"The results should lend support to clinicians considering the possibility of advising their patients to discontinue their prescribed opioids in favor of topical analgesics, as much as possible," Dr. Gudin told Practical Pain Management.

"Topical analgesics are effective for a variety of types of pain," said Dr. Gudin, "Our study supports the fact that we can eliminate opioid use in a certain percentage of patients with chronic pain conditions."

Expert Perspective on the Value of the Study Findings

The finding that more than half of the patients were able to stop taking opioids when provided a topical medication that addressed their pain is the good news, of course, said John Claude Krusz, PhD, MD, medical director of Anodyne Headache PainCare and Well-Being in Dallas, Texas who evaluated the study for Practical Pain Management.

''I like the idea that we may be able to take 50% of our patients off prescribed opioids, which is amazing to me," he said. However, he tempered that enthusiasm with a caveat, citing the small sample size. ''These findings still need to be replicated with a larger number of patients," he said.

He also cited the drop out rate—from 121 at baseline and three months to 27 at six months—as a limitation.1

Yet, Dr. Krusz agreed that it is worthwhile for clinicians to feel encouraged to consider recommending topical agents for appropriate patients with responsive pain conditions. As for which topicals he finds most effective, Dr. Krusz recommended baclofen, ketamine (3-5%) and lidocaine (7-8%). "Those are the most acceptable to me," he said.

Dr. Gudin is a consultant for Clarity Science, an international scientific research company, which supported the research. Dr. Krutz had no financial no disclosers.

Last updated on: December 15, 2017
Continue Reading:
Strategies for Weaning Opioids in Patients With an Opioid Use Disorder and Chronic Pain

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