NSAIDs
Preparations containing benzydamine, diclofenac and ibuprofen are available without prescription. The rationale for their use is that they act directly at the affected site, avoiding the systemic adverse effects and side-effects of oral administration. Only a small proportion of an NSAID penetrates through the skin, but once absorbed it shows a strong affinity for tissues. Clinical evidence indicates that topical NSAIDs are effective over short periods for musculoskeletal conditions and have a very low incidence of adverse effects.1 Topical NSAIDs are licensed for the treatment of backache, rheumatic and muscular pain, sprains and strains, including sports injuries, and for pain relief in non-serious arthritic conditions. They are generally well tolerated, although side-effects associated with oral NSAIDs can occur, especially if large amounts are applied. Topical NSAIDs (except benzydamine) are contraindicated in patients who are sensitive to aspirin and other NSAIDs, and they are not recommended for use by pregnant or breastfeeding women or for children under 14 years of age. Clinically significant drug interactions are unlikely. Presentations of topical NSAIDs include creams, gels, mousses and sprays.

RUBEFACIENTS (COUNTERIRRITANTS)
Rubefacients are compounds that produce local vasodilation and create a sensation of warmth, exerting an analgesic effect by masking the perception of pain. Massaging enhances their effect and also helps to disperse local tissue pain mediators. Most proprietary rubefacient preparations are mixtures of several ingredients, including salicylates, nicotinates and counterirritant substances from natural sources, such as capsicum oleoresin, turpentine oil, camphor and menthol. Although widely available and used, evidence does not support the use of topical rubefacients for acute injuries.2 Products containing salicylates should be avoided by people who are sensitive to aspirin.