No proof' that muscle rubs work

Larger and higher quality controlled trials of topical rubefacients are needed to establish whether these treatments really work.

"We also need more studies on other rubefacients as we were only able to assess the effectiveness of the salicylate formulations in this review.

"But it is important to remember that not all analgesic gels or creams are the same, and for others there is very good evidence of effectiveness."

Peter Gladwell, a clinical specialist physiotherapist working in pain management, said some patients might want to try rubefacients alongside other treatments, including exercise and relaxation techniques.

"A patient with chronic pain, considering the possible use of a rubefacient, will learn from this review that they have a one in six chance of achieving 50% pain relief.

"They have a one in three chance of achieving 50% pain relief using a non-steroidal anti-inflammatory gel."

He suggests, after weighing the risks and benefits and having talked with a health professional, a patient may want to try the anti-inflammatory gel first, and move on to try a rubefacient if the anti-inflammatory gel is unhelpful.