10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices
|1st choice||Ibuprofen 5% gel||Dose:|
Apply up to 3 times a day as per product directions
- Topical NSAIDs may be considered as additional pain relief for people with knee or hand osteoarthritis. Topical NSAIDs should be considered before oral NSAIDs.
- All topical NSAIDS are considered equally efficacious.
- Patients should be advised against excessive exposure to sunlight of area treated in order to avoid possibility of photosensitivity.
- The evidence available does not support the use of topical rubefacients in acute or chronic musculoskeletal pain.
- Evidence to support the use of use of topical capsaicin is limited.
- A preparation containing capsaicin 0.025% (Zacin® cream) can be considered as an adjunct in hand or knee osteoarthritis. It may need to be used for 4 weeks before pain is relieved; pain relief usually starts within the first week of treatment and increases with continuing regular application (four times daily). Stop if ineffective after being used correctly for 4-6 weeks.
- A capsaicin 0.075% cream (Axsain®) is licensed for the symptomatic relief of postherpetic neuralgia after lesions have healed, and for the relief of painful diabetic neuropathy. Capsaicin 0.075% cream requires specialist input for application in painful diabetic neuropathy. NICE also recommend capsaicin 0.075% cream for people with localised neuropathic pain who wish to avoid, or cannot tolerate, oral treatments – see 4.7.3
- Kaolin poultices are not recommended for prescribing on the NHS.