What is the role of compounded cream in managing bone spurs?

Compounded Creams for Bone Spurs: Limited Evidence and Role in Management

There is no strong evidence supporting the use of compounded creams as a primary treatment for bone spurs, and they should not be considered a first-line therapy for managing bone spur pain.

Understanding Bone Spurs

Bone spurs (osteophytes and enthesophytes) are abnormal projections of bone that can form:

• Around joint lines (osteophytes)
• At insertion sites of tendons or ligaments (enthesophytes) 1
• Commonly in the calcaneus (heel) causing heel pain 2

Evidence-Based Treatment Approach for Bone Spurs

First-Line Treatments

1. Non-pharmacological interventions:

   • Regular education about the condition
   • Targeted exercise programs
   • Weight reduction if applicable
   • Appropriate footwear and insoles 3

2. Topical treatments with evidence:

   • Topical NSAIDs (better evidence than compounded creams)
   • Topical capsaicin (0.025-0.075%) applied 3-4 times daily for 2-4 weeks
     • Effective for mild-to-moderate pain in osteoarthritis
     • Works by depleting substance P in a reversible fashion
     • Initial burning sensation diminishes with continued use 4

Second-Line Treatments

1. Oral medications:

   • Acetaminophen (up to 4g/day with caution for hepatotoxicity)
   • NSAIDs (with caution in patients with cardiovascular, renal disease, or GI risk) 3

2. Injectable therapies:

   • Corticosteroid injections for acute pain exacerbations
   • Hyaluronic acid injections (evidence supports for knee OA but not for hip OA) 3
   • Limited evidence for PRP injections 3

Surgical Approaches (for refractory cases)

For persistent symptoms despite conservative management:

• Arthroscopic procedures for calcaneal spurs have shown good results 5
• A four-step surgical approach for plantar fasciitis with bone spurs has demonstrated significant improvement in pain and function 6

Compounded Creams: Limited Evidence

Current guidelines and research do not specifically address or support compounded creams for bone spurs. While some components commonly used in compounded creams (such as NSAIDs or capsaicin) have evidence individually, the specific combinations in compounded preparations lack robust clinical trial data.

Key Considerations for Topical Treatments

1. Anatomical considerations:

   • Topical treatments work best for superficial joints
   • Deep joints (like hip) may have limited benefit from topical applications 4

2. Patient education for topical treatments:

   • Explain the delayed onset of action (2-4 weeks for capsaicin)
   • Warn about initial sensations (burning with capsaicin)
   • Emphasize consistent application for optimal results 4

When to Consider More Advanced Interventions

Progress to more invasive treatments when:

• Pain persists despite 3-6 months of conservative therapy 5
• Functional limitations significantly impact quality of life
• Imaging confirms bone spur as the primary pain generator

Conclusion

For bone spur management, clinicians should follow an evidence-based approach starting with proven non-pharmacological and pharmacological options before considering compounded creams, which lack specific supporting evidence. If topical treatment is desired, standardized preparations with established efficacy (like capsaicin or topical NSAIDs) should be preferred over compounded formulations.