Insufficient evidence of benefit of topical rubefacients for musculoskeletal pain in adults

January 01, 0001

Insufficient evidence of benefit of topical rubefacients for musculoskeletal pain in adults

Clinical Question: How effective are topical rubefacients for acute and chronic painful musculoskeletal conditions in adults?

Bottom line: Although the analysis of all studies in acute conditions produced a significant benefit compared with placebo at 7 days, with NNT* 3 for 50% pain relief, this finding was based on only 4 heterogeneous studies. Analysis of 6 studies in chronic conditions produced a significant benefit compared with placebo at 14 days, with NNT 6 for 50% pain relief. However, this compares poorly with the efficacy of topical non-steroidal anti-inflammatory drugs (NNT 3). Topical salicylates do appear to be relatively well-tolerated in the short term, though the conclusion is limited by a relatively small number of participants. There is no evidence for topical rubefacients with other components. * NNT = number needed to treat to benefit 1 individual

Caveat: Studies were generally small. There was a variety of interventions and outcomes used in these studies, and a range of different methods for measuring pain intensity or pain relief. Adverse events and withdrawals were generally poorly reported with little detail provided. Most studies did not provide details of the volume of cream applied, though some specified the application schedule.

Context: Rubefacients (containing salicylates or nicotinamides) cause irritation of the skin, and are believed to relieve various musculoskeletal pains. They are available on prescription, and are common components in over-the-counter preparations.

Cochrane Systematic Review: Matthews P et al. Topical rubefacients for acute and chronic pain in adults. Cochrane Reviews 2009, Issue 3. Article No. CD007403. DOI:10.1002/14651858.CD007403.pub2. This review contains 16 studies involving 1276 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 215, January 2010.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: M. Muskuloskeletal. Keywords: topical, rubefacients, treatment, musckulskeletal pain, analgesia
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 27 April 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.