Study: compounding topical therapy in the treatment of chronic pain

In the traditional treatment of chronic pain, sustained pain remission is rarely achieved by oral systemic medications alone due to their dose-limiting adverse effects. In our experience, chronic pain is treated safely and effectively with topical medications, and local prescribers have been utilizing topical analgesics more frequently as an adjunctive therapy in their treatment regimens. As the medication avoids the gastrointestinal tract, less adverse GI events occur when compared with oral NSAIDs. A commonly prescribed combination topical analgesic, Compound A, contains five active ingredients: ketamine, gabapentin, flurbiprofen, cyclobenzaprine and bupivacaine in PCCA Lipoderm® transdermal cream base.


The data was compiled from an observational, single center, open label survey of patients who received the combination topical compounded analgesic medication (Compound A) with no comparator group between the dates of June 1, 2014 and July 1, 2014. The data collected did not account for any specific therapies that may have been prescribed concurrently, including but not limited to: oral medications, steroid injections, or physical therapy. Of the 339 patients surveyed, 54 responses were received (response rate 15.93%). The average age of participants was 55 years old, and 42.6% (n=23) were male, while 57.4% (n=31) were female.


Respondents reported their average pain level before starting compound therapy and again after an average of 46.63 days of treatment with Compound A. The average pain reduction of respondents using a standard numerical pain scale was 3.979 ± 2.119 points or a 50.52% reduction. Patients felt relief for an average of 4.889 ± 2.793 hours after application. Of the 54 respondents, 45 report an ability to stay active longer, while 37 report an increased range of motion in the affected area. Overall, 51 respondents feel that compound therapy is helping them.


Although small, our open label survey suggests that the combination topical analgesic, Compound A, was useful in reducing chronic pain as reported by our respondents using a standard pain scale. While the analysis of our data is limited only to the 54 patients who responded and cannot accurately be extrapolated to any larger patient population, the data is encouraging and warrants further consideration. More research is needed to confirm the analgesic effects of compounded topical creams and their use as a possible alternative to conventional therapies in chronic pain management.