Systematic review of efficacy of topical rubefacients containing salicylates for the treatment of acute and chronic pain

doi:10.1136/bmj.38040.607141.EE

BMJ 2004;328:995 (24 April), doi:10.1136/bmj.38040.607141.EE (published 19 March 2004)

Primary care

Systematic review of efficacy of topical rubefacients containing salicylates for the treatment of acute and chronic pain

Lorna Mason, research associate¹, R Andrew Moore, director of research¹, Jayne E Edwards, senior researcher¹, Henry J McQuay, professor of pain relief¹, Sheena Derry, senior researcher¹, Philip J Wiffen, coordinating editor, Cochrane Pain and Palliative Care Group¹

¹ Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, Headington, Oxford OX3 7LJ

Correspondence to: R A Moore andrew.moore{at}pru.ox.ac.uk

Objective To determine the efficacy and safety of topical rubefacientscontaining salicylates in acute and chronic pain.

Data sources Electronic databases and manufacturers of salicylates.

Study selection Randomised double blind trials comparing topicalrubefacients with placebo or another active treatment, in adultswith acute or chronic pain, and reporting dichotomous information,around a 50% reduction in pain, and analyses at one week foracute conditions and two weeks for chronic conditions.

Data extraction Relative benefit and number needed to treat,analysis of adverse events, and withdrawals.

Data synthesis Three double blind placebo controlled trialshad information on 182 patients with acute conditions. Topicalsalicylate was significantly better than placebo (relative benefit3.6, 95% confidence interval 2.4 to 5.6; number needed to treat2.1, 1.7 to 2.8). Six double blind placebo controlled trialshad information on 429 patients with chronic conditions. Topicalsalicylate was significantly better than placebo (relative benefit1.5, 1.3 to 1.9; number needed to treat 5.3, 3.6 to 10.2), butlarger, more valid studies were without significant effect.Local adverse events and withdrawals were generally rare intrials that reported them.

Conclusions Based on limited information, topically appliedrubefacients containing salicylates may be efficacious in thetreatment of acute pain. Trials of musculoskeletal and arthriticpain suggested moderate to poor efficacy. Adverse events wererare in studies of acute pain and poorly reported in those ofchronic pain. Efficacy estimates for rubefacients are unreliableowing to a lack of good clinical trials.

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... and salicylate works better in acute pain
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