10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices

General guidance

• Rubefacients act by counter-irritation. Pain, whether superficial or deep-seated may be relieved by any method which itself produces irritation of the skin. Counter-irritation is comforting in painful lesions of the muscles, tendons, and joints, and in non-articular rheumatism.
• Rubefacients probably all act through the same essential mechanism and differ mainly in the intensity and duration of action.

Recommended drugs

Ibuprofen gel

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low