The Workers’ Compensation Research Institute (WCRI) recently published Topical Analgesic Use in Workers’ Compensation, a report that examines how often topical analgesics are dispensed, what types of topical analgesics are being dispensed, and if their prescribing is in line with guideline recommendations.
What are Topical Analgesics?
Topical analgesics are pain medications applied directly to the skin, directly on the area to be treated, including patches, creams, gels, sprays, ointments, and solutions. While topical analgesics are an important option for treating certain musculoskeletal and neuropathic pain conditions, topical pain medications are making up a greater portion of drug spend.
In a previous WCRI study from 2020, topical analgesics made up 19% of prescription payments in a median of 28 study states, significant growth from 9% in 2015.
This new study examined 480,000 workers’ comp claims with prescriptions that had injuries between January 1, 2018 and March 31, 2019, across 28 states. Prescription utilization and medical diagnoses was tracked for a 12-month period following injury through March 31, 2020.
Wide variation in the dispensing of topical analgesics was seen across the 28 study states. Across Connecticut, Florida, Georgia, Louisiana, Nevada, and New York, anywhere from 13-17% of workers with any medication dispensed received at least one prescription for topical analgesics. However, in Arkansas, Iowa, and Texas, only 3% of such workers received a prescription for a topical analgesic.
Prescription strength topical analgesics such as Lidoderm, Voltaren Gel, and Pennsaid were the most frequently prescribed category, accounting for 68% of prescriptions and 59% of payments for topical analgesics. Private-label topics were the second most frequently prescribed topical analgesics, accounting for 16% of prescriptions and 32% of topical analgesic payments. Over-the-counter (OTC) topicals accounted for 12% of prescriptions but only 1% of payments due to lower costs. Custom compounds and compound kits made a small share of topical analgesics overall.
Compared with all workers with prescriptions, those prescribed a topical analgesic were more likely to be older, female, have a higher total prescription utilization, and have a higher prevalence of inflammations, sprains and strains, and neurologic spine pain injuries. Furthermore, these individuals were more likely to have their prescriptions filled at a physician’s office.
Safety and Efficacy Risks
The increased utilization of topical analgesics comes with some concerns due to certain prescribing trends. Private-label topicals (PLTs) and compounds make up a portion of topical analgesics, and neither of those drug categories are approved by the FDA or evaluated for efficacy or safety in randomized clinical trials.
Additionally, PLTs can have two to three times the FDA-recommended concentration of certain ingredients, and can have much higher costs without offering any clinical benefit. Healthesystems pharmacist Kim Blount explains more in this video.
Furthermore, some topical analgesics – such as topical NSAIDs – are routinely prescribed in ways not recommended by evidence-based guidelines.
Physician Dispensing of Topical Analgesics
A majority of workers with topical analgesic prescriptions filled their prescriptions at physicians’ offices in several states. In 10 states, 50-70% of workers had physician-dispensed topical analgesics.
In half the study states, workers were infrequently dispensed PLTs, but nearly a third of workers with topical analgesics were prescribed PLTs in Illinois, Louisiana, Maryland, New Mexico, and South Carolina. An even higher rate of 61% was seen in Delaware.