Saturday Quack – Those Heat-Producing Creams and Gels Don’t Relieve Pain

There’s little evidence that over-the-counter liniments and embrocations such as Hot-Ice® or Oil of Wintergreen really work as advertised.  It’s long been thought that producing a redness response in the skin can act as a counterirritant, and is a way of reducing underlying muscle pain.  However, a Cochrane Systematic Review published earlier this year finds that such ‘rubefacients’ are, in a word, ineffective.

A comprehensive research of the medical literature revealed 6 placebo-controlled and one analgesic-controlled study for acute pain, and 7 placebo and 2 analgesic-controlled studies for chronic pain that met the criteria for inclusion in the analysis.  As the review puts it: “This review found . . . in acute pain conditions like strains and sprains . . .there was inadequate information to support the use of rubefacients.  In chronic pain conditions such as osteoarthritis the evidence was more robust, but rubefacients appear to provide useful levels of pain relief in one in six individuals over and above those who also responded to placebo.  This compares poorly with topical NSAIDs (non-steroid anti-inflammatory drugs) where substantial amounts of good quality evidence indicate that one in every three individuals treated will experience useful levels of pain relief over and above those who also responded to placebo.”

In even fewer words, if you have acute or chronic muscular or joint pain, you’d do better to use a known effective analgesic, such as a topical NSAID (e.g. Voltaren-Gel®), rather than a heat-producing liniment, gel, or wrap.