10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices

NICE clinical guideline 177 – Osteoarthritis: Paracetamol and/or topical NSAIDs should be offered to patients with knee or hand osteoarthritis before considering oral NSAIDs, COX-2 inhibitors or opioids.

Treatment should be reviewed after two weeks and stopped if not effective.


(including topical products containing nicotinate compounds, salicylate compounds, essential oils and camphor)

Not recommended for use due to lack of evidence of efficacy. Click here for more information. Prescribers should not initiate rubefacients for any new patient. Click the following link for a patient information leaflet to support deprescribing

Topical NSAIDS


  • Zacin® cream containing 0.025% capsaicin (£17.71 = 45g)
  • Axsain® cream containing 0.075% capsaicin (£14.58 = 45g)


  • Capsaiscin 0.025% is licensed for the symptomatic relief of osteoarthritis. It may need to be used for 1-2 weeks before pain is relieved
  • Capsaicin 0.075% cream is licensed for the symptomatic relief of postherpetic neuralgia after lesions have healed, and for the relief of painful diabetic neuropathy


  1. Topical capsaicin has been included for use although trial data is poor and its place is uncertain in pain relief
Capsaicin patch
  • Quetenza® patches, self-adhesive capsaicin 179mg (8%)


  1. For use in line with the Peninsula Health Technology Commissioning Group Commissioning decision: capsaicin patch (Qutenza®) for the treatment of neuropathic pain


Home > Formulary > Chapters > 10. Musculoskeletal & joint diseases > 10.3 Drugs for the treatment of soft-tissue disorders and topical pain relief > 10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices


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