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Andrew Moore has consulted with companies that manufacture analgesics, including topical analgesics. Andrew Moore is an author and editor for the Cochrane Pain, Palliative, and Supportive care group, and until recently was the chairman of the International Study of Pain special interest group on systematic reviews and evidence.

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Republish our articles for free, online or in print, under Creative Commons licence. I was a clumsy child and had more than my fair share of bumps and knocks. My younger self did not regard this as helpful; I wanted the pain gone, now.

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A bit of a brat, perhaps, but if you ask people with pain — any kind of pain, be it acute pain after a fall or operation, a headache, or chronic pain like arthritis — what they want from treatment, it is the same as I wanted all those years ate. Pain gone, now. There may be something in the idea that rubbing a painful area might actually help. We rub the skin over a painful area almost instinctively.

Touch applied at particular frequency can be pleasant. And while there is research that shows that it might help, it is a big jump to demonstrate that rubbing alone is a useful treatment for pain if that pain is moderate or severe.

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But what about rubbing something on to a painful area — a cream or a gel? There are all sorts of these.

Some aim to cool, gack to produce a sense of heat, some contain drugs like nonsteroidal anti-inflammatory drugs NSAIDsor capsaicin, an extract of chilli. Some are for acute pain, some for chronic, some you can buy over the counter from the chemist, and others need a prescription.

Any large pharmacy has a bewildering array of products. How do you choose? Are any better than just rubbing?

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Help comes in the form of a new Cochrane overview review that draws together all the current evidence. The overview pulled together results from 13 Cochrane reviews, with individual trials and around 30, participants, to assess the benefits and harms of a range of topical applied to the skin painkillers for a range Need a quick back rub any age over 18 conditions.

The main outcome was whether people with moderate or severe pain had their pain reduced to no worse than mild pain with treatment. And the comparison was between rubbing on the test medicine and rubbing on a placebo medicine that was identical in every way except that it had no active ingredient.

Both were rubbed on in the same way to discount the effects of rubbing itself. First, the good news. A good result here as the pain was reduced from moderate or severe to no worse than mild after about a week. The gel is important, because the same drugs in creams or plasters were not so effective and there are probably good reasons for that.

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In chronic pain conditions, the news fub less good. Good pain relief was going from moderate or severe pain to no worse than mild pain. For many other rubbed-on products for pain relief herbal remedies, salicylates, menthols, and some NSAID preparations we have no evidence or so little evidence that we cannot ahe it. It may work, but if you buy it, you have no idea whether you are buying something really good or just wasting your money.

Experience suggests the latter, but if you have a remedy you swear by, stick with it. Rubbed-on painkillers are designed to work locally, however.

While there may be some local reactions such as itching or rednessthe good news is that effects on other parts of the body such as nausea or dyspepsia and serious side effects such as bleeding are rare because Looking for a tight body levels of drugs that are rubbed on are much lower than when they are taken orally.

Available editions United Kingdom. Andrew MooreUniversity of Oxford. Some topical painkillers contain capsaicin, an extract of chilli.

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