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Rubefacientes que contienen salicilato para el dolor osteomuscular agudo y crónico en adultos

Appendices

Appendix 1. CENTRAL search strategy (2014 update)

  1. MESH descriptor Irritants EXPLODE ALL TREES (187)

  2. (rubefacient OR "counter‐irritant" OR "ammonium salicylate" OR "radian B" OR "benzyl nicotinate" OR kausalpunkt OR pykaryl OR rubriment OR "bornyl salicylate" OR camphor OR "choline salicylate" OR "diethylamine salicylate" OR algesal OR algoderm OR algoflex OR artogota OR "Lloyd's cream" OR physiogesic OR rheumagel OR "transvasin heat spray" OR "diethyl salicylate" OR "ethyl nicotinate" OR mucotherm OR transvasin "PR heat spray" OR "ethyl salicylate" OR "glycol monosalicylate" OR ralgex OR salonpas OR intralgin OR "glycol salicylate" OR "algipan rub" OR menthol OR "methyl butetisalicylate" OR doloderm OR "methyl gentisate" OR "methyl nicotinate" OR "nella red oil" OR wintergreen OR "sweet birch oil" OR "methyl salicylate" OR aezodent OR argesic OR aspellin OR balmosa OR "bengue's balsam" OR "chymol emollient balm" OR " deep heat" OR dencorub OR dermacreme OR dubam OR eftab OR exocaine OR germolene OR "gone balm" OR gordogesic OR linsal OR salonpas OR intralgin OR mentholatum OR monophytol OR nasciodine OR phlogont rheuma OR "PR heat spray" OR ralgex OR rheumabad OR rheumax OR salonair OR thermo‐rub OR nicoboxil OR finalgon OR ortholan OR nonivamide OR Warme‐Pflaster OR picolamine OR salicylate OR algiospray OR reflex OR "propyl nicotinate" OR elacur OR nicodan OR salicylamide OR isosal OR salicylate OR salycilic OR movelat OR radian OR "thurfyl salicylate" OR "triethanolamine salicylate" OR "analgesia crme" OR antiphlogistine OR aspercreme OR Ben‐Gay OR bexidermil OR dencorub OR exocaine OR metsal OR miosal OR mobisyl OR myoflex OR pro‐gesic OR royflex OR sportscreme OR topicrem): TI,AB,KY (4095)

  3. 1 OR 2 (4273)

  4. MESH descriptor Administration, topical EXPLODE ALL TREES (12155)

  5. (topical* OR cutaneous OR dermal OR transcutaneous OR transdermal OR percutaneous OR skin OR massage OR embrocation OR gel OR ointment OR aerosol OR cream OR creme OR lotion OR mousse OR foam OR liniment OR spray OR rub OR balm OR salve OR emulsion OR oil OR patch OR plaster): TI,AB,KY (65584)

  6. 4 OR 5 (68135)

  7. MESH descriptor Athletic injuries EXPLODE ALL TREES (411)

  8. (strain OR sprain* OR "sports injury"): TI,AB,KY (3671)

  9. MESH descriptor Musculoskeletal diseases EXPLODE ALL TREES (20514)

  10. (arthrit* OR rhemat* or osteoarth* OR tend?nitis OR sciatica OR lumbago OR fibrositis): TI,AB,KY (12221)

  11. 7 OR 8 OR 9 OR 10 (29202)

  12. (pain OR painful OR analgesi*): TI,AB,KY (71595)

  13. 3 AND 6 AND 11 AND 12 (43)

Appendix 2. MEDLINE search strategy (2014 update)

  1. exp Irritants/ (12084)

  2. (rubefacient OR "counter‐irritant" OR "ammonium salicylate" OR "radian B" OR "benzyl nicotinate" OR kausalpunkt OR pykaryl OR rubriment OR "bornyl salicylate" OR camphor OR "choline salicylate" OR "diethylamine salicylate" OR algesal OR algoderm OR algoflex OR artogota OR "Lloyd's cream" OR physiogesic OR rheumagel OR "transvasin heat spray" OR "diethyl salicylate" OR "ethyl nicotinate" OR mucotherm OR transvasin "PR heat spray" OR "ethyl salicylate" OR "glycol monosalicylate" OR ralgex OR salonpas OR intralgin OR "glycol salicylate" OR "algipan rub" OR menthol OR "methyl butetisalicylate" OR doloderm OR "methyl gentisate" OR "methyl nicotinate" OR "nella red oil" OR wintergreen OR "sweet birch oil" OR "methyl salicylate" OR aezodent OR argesic OR aspellin OR balmosa OR "bengue's balsam" OR "chymol emollient balm" OR " deep heat" OR dencorub OR dermacreme OR dubam OR eftab OR exocaine OR germolene OR "gone balm" OR gordogesic OR linsal OR salonpas OR intralgin OR mentholatum OR monophytol OR nasciodine OR phlogont rheuma OR "PR heat spray" OR ralgex OR rheumabad OR rheumax OR salonair OR thermo‐rub OR nicoboxil OR finalgon OR ortholan OR nonivamide OR Warme‐Pflaster OR picolamine OR salicylate OR algiospray OR reflex OR "propyl nicotinate" OR elacur OR nicodan OR salicylamide OR isosal OR salicylate OR salycilic OR movelat OR radian OR "thurfyl salicylate" OR "triethanolamine salicylate" OR "analgesia crme" OR antiphlogistine OR aspercreme OR Ben‐Gay OR bexidermil OR dencorub OR exocaine OR metsal OR miosal OR mobisyl OR myoflex OR pro‐gesic OR royflex OR sportscreme OR topicrem).mp. (99561)

  3. 1 OR 2 (111385)

  4. exp Administration, topical/ (67911)

  5. (topical* OR cutaneous OR dermal OR transcutaneous OR transdermal OR percutaneous OR skin OR massage OR embrocation OR gel OR ointment OR aerosol OR cream OR creme OR lotion OR mousse OR foam OR liniment OR spray OR rub OR balm OR salve OR emulsion OR oil OR patch OR plaster).mp. (1380924)

  6. 4 OR 5 (1396722)

  7. exp Athletic injuries/ (29773)

  8. (strain OR sprain* OR "sports injury").mp. (296402)

  9. exp Musculoskeletal diseases/ (842839)

  10. (arthrit* OR rhemat$* or osteoarth* OR tend?nitis OR sciatica OR lumbago OR fibrositis).mp. (215793)

  11. 7 OR 8 OR 9 OR 10 (1179700)

  12. (pain OR painful OR analgesi*).mp. (537105)

  13. randomized controlled trial.pt. (385551)

  14. controlled clinical trial.pt. (89638)

  15. randomized.ab. (282279)

  16. placebo.ab. (149897)

  17. drug therapy.fs. (1733690)

  18. randomly.ab. (199106)

  19. trial.ab. (292620)

  20. groups.ab. (1274063)

  21. 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 (3262413)

  22. 3 AND 6 AND 11 AND 12 AND 21 (106)

  23. Limit 22 to yr="2008 ‐ Current" (35)

Appendix 3. EMBASE search strategy (2014 update)

  1. exp Irritants/ (2671)

  2. (rubefacient OR "counter‐irritant" OR "ammonium salicylate" OR "radian B" OR "benzyl nicotinate" OR kausalpunkt OR pykaryl OR rubriment OR "bornyl salicylate" OR camphor OR "choline salicylate" OR "diethylamine salicylate" OR algesal OR algoderm OR algoflex OR artogota OR "Lloyd's cream" OR physiogesic OR rheumagel OR "transvasin heat spray" OR "diethyl salicylate" OR "ethyl nicotinate" OR mucotherm OR transvasin "PR heat spray" OR "ethyl salicylate" OR "glycol monosalicylate" OR ralgex OR salonpas OR intralgin OR "glycol salicylate" OR "algipan rub" OR menthol OR "methyl butetisalicylate" OR doloderm OR "methyl gentisate" OR "methyl nicotinate" OR "nella red oil" OR wintergreen OR "sweet birch oil" OR "methyl salicylate" OR aezodent OR argesic OR aspellin OR balmosa OR "bengue's balsam" OR "chymol emollient balm" OR " deep heat" OR dencorub OR dermacreme OR dubam OR eftab OR exocaine OR germolene OR "gone balm" OR gordogesic OR linsal OR salonpas OR intralgin OR mentholatum OR monophytol OR nasciodine OR phlogont rheuma OR "PR heat spray" OR ralgex OR rheumabad OR rheumax OR salonair OR thermo‐rub OR nicoboxil OR finalgon OR ortholan OR nonivamide OR Warme‐Pflaster OR picolamine OR salicylate OR algiospray OR reflex OR "propyl nicotinate" OR elacur OR nicodan OR salicylamide OR isosal OR salicylate OR salycilic OR movelat OR radian OR "thurfyl salicylate" OR "triethanolamine salicylate" OR "analgesia crme" OR antiphlogistine OR aspercreme OR Ben‐Gay OR bexidermil OR dencorub OR exocaine OR metsal OR miosal OR mobisyl OR myoflex OR pro‐gesic OR royflex OR sportscreme OR topicrem).mp. (89247)

  3. 1 OR 2 (91804)

  4. exp Administration, topical/ (14446)

  5. (topical* OR cutaneous OR dermal OR transcutaneous OR transdermal OR percutaneous OR skin OR massage OR embrocation OR gel OR ointment OR aerosol OR cream OR creme OR lotion OR mousse OR foam OR liniment OR spray OR rub OR balm OR salve OR emulsion OR oil OR patch OR plaster).mp. (1214203)

  6. 4 OR 5 (1214204)

  7. exp Athletic injuries/ (15192)

  8. (strain OR sprain* OR "sports injury").mp. (461094)

  9. exp Musculoskeletal diseases/ (1041957)

  10. (arthrit* OR rhemat* or osteoarth* OR tend?nitis OR sciatica OR lumbago OR fibrositis).mp. (222168)

  11. 7 OR 8 OR 9 OR 10 (1505520)

  12. (pain OR painful OR analgesi*).mp. (706918)

  13. clinical trial.sh. (686097)

  14. controlled clinical trial.sh. (340752)

  15. randomized controlled trial.sh. (302635)

  16. double‐blind procedure.sh. (90931)

  17. (clin* adj25 trial*).ab. (285240)

  18. ((doubl* or trebl* or tripl*) adj25 (blind* or mask*)).ab. (98024)

  19. placebo*.ab. (151862)

  20. random*.ab. (749790)

  21. 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20

  22. 3 AND 6 AND 11 AND 12 AND 21

  23. Limit 22 to yr="2008 ‐ Current" (74)

Appendix 4. Summary of outcomes in individual studies: efficacy and use of rescue medication

Analgesia

Study ID

Treatment

Outcome measure

Success

Rescue Medication

Acute

Diebschlag 1987

(1) Salicylate, adrenal extract, and mucopolysaccharide ointment (Mobilat)

(2) Placebo ointment

Movement pain on 100 mm VAS at:

(a) 8 days

(b) 15 days

No dichotomous data

(a) Significant difference in favour of (1)

(b) Significant difference in favour of (1)

No data

Frahm 1993

(1) Salicylate and mucopolysaccharide cream (Movelat)

(2) Placebo cream

Movement pain on 100 mm VAS at:

(a) 9 days

(b) 11 days

No dichotomous data

(a) Significant difference in favour of (1)

(b) No significant difference

No data

Ginsberg 1987

(1) Salicylate and capsicum oleoresin ointment (Rado‐Salil)

(2) Placebo ointment

Patient global assessment ('excellent' or 'good') at:

(a) 3 days

(b) 14 days

(a)

(1) 5/20

(2) 0/20

(b)

(1) 10/20

(2) 2/20

Total number of rescue tablets (250 mg paracetamol) used:

(1) 24

(2) 36

Ibanez 1988

(1) Salicylate spray

(2) Fepradinol spray active control

"Cure" at 12 days

(1) 23/35

(2) 85/102

No data

Lester 1981

(1) Salicylate, adrenal extract, and mucopolysaccharide gel (Movelat)

(2) Placebo gel

Relief of pain by 7 days

(1) 18/20

(2) 13/22

No data

Rothhaar 1982

(1) Salicylate gel (Reparil‐Gel)

(2) Placebo gel

Patient global assessment ('very good' or 'good') at 9 days

(1) 37/39

(2) 3/42

No data

Stam 2001

(1) Salicylate, nicotinate, capsicum oleoresin, and histamine gel (Cremor Capsici Compositus FNA)

(2) Herbal gel (Spiroflor SRL) active control

80% reduction in pain on 100 mm VAS at 7 days

(1) 41/78

(2) 40/83

Number using rescue medication (paracetamol):

(1) 65/82

(2) 56/75

Chronic

Algozzine 1982

(1) Salicylate cream (Myoflex)

(2) Placebo cream

Pain relief score at 7 days favours (1) or (2)

No first period data. Combined periods: (1) 10/25

(2) 8/25

No data

Camus 1975

(1) Salicylate and myrtecaine cream (Algesal Suractive)

(2) Placebo cream

Improvement in rest pain score at 10 days

(1) 8/10

(2) 3/10

No data

Geller 1980

(1) Salicylate and heparin gel (Dolo‐Menthoneurin)

(2) Etofenamate gel active control

Patient global score ('very good' or 'good') after phase 1 at 7 days

First period data

(1) 24/25

(2) 8/25

No data

Golden 1978

(1) Salicylate cream (Aspercreme) + placebo tablets

(2) Aspirin tablets + placebo cream active control

Patient global assessment of pain relief ('excellent' or 'good') at 7 days

(1) 13/20

(2) 10/20

No data

Lobo 2004

(1) Salicylate cream (Theraflex‐TMJ)
(2) Placebo cream

Spontaneous pain VAS (10 cm) at:

(a) 15 days

(b) 10 days

No dichotomous data

(a) Significant difference in favour of (1)

(b) No significant difference

No data

Rutner 1995

(1) Salicylate gel (Phardol‐Mono)

(2) Placebo gel

Dropout 'pain free' by day 14

(1) 21/54

(2) 18/59

No data

Shackel 1997

(1) Salicylate gel

(2) Placebo gel

Patient global assessment ('very good' or 'good') at 28 days

(1) 22/58

(2) 21/56

Number using rescue medication (paracetamol):

(1) 43/56

(2) 39/55

Average dose (mg/day):

(1) 555

(2) 600

von Bach 1979

(1) Salicylate and nonivamide in heparin and salicylate ointment (Enelbin‐Rheuma)

(2) Salicylate in heparin and salicylate ointment active control

Global assessment ('very good' or 'good') at 14 days

(1) 27/50

(2) 10/50

No data

Wanet 1979

(1) Salicylate and myrtecaine cream (Algesal Suractive)

(2) Placebo cream

Rest pain score at 15 days

(1) 15/32

(2) 4/24

No data

Zahmatkash 2011

(1) Salicylate ointment

(2) Herbal (cinnamon, ginger, mastic, sesame oil) ointment

Reduction in pain intensity (group mean)

14 days

(1) 13/100

(2) 13/100

28 days

(1) 19/100

(2) 21/100

42 days

(1) 22/100

(2) 25/100

No data

VAS: visual analogue scale

Appendix 5. Summary of outcomes in individual studies: adverse events and withdrawals

Withdrawals and exclusions

Adverse events

Study ID

Treatment

All withdrawals and exclusions

Lack of efficacy

Adverse events

All adverse events

Local adverse events

Algozzine 1982

(1) Salicylate cream (Myoflex)

(2) Placebo cream

1/26

unrelated to study

(1) 0/25

(2) 0/25

(1) 0/25

(2) 0/25

(1) 0/25

(2) 0/25

(1) 0/25

(1) 0/25

Camus 1975

(1) Salicylate and myrtecaine cream (Algesal Suractive)

(2) Placebo cream

No data

No data

No data

No data

No data

Diebschlag 1987

(1) Salicylate, adrenal extract, and mucopolysaccharide ointment (Mobilat)

(2) Placebo ointment

No data

No data

(1) 0/40

(2) 0/40

(1) 0/40

(2) 0/40

(1) 0/40

(2) 0/40

Frahm 1993

(1) Salicylate and mucopolysaccharide cream (Movelat)

(2) Placebo cream

7/16

violation of protocol

(1) 0/78

(2) 0/78

(1) 0/78

(2) 0/78

(1) 0/78

(2) 1/78

(1) 0/78

(2) 1/78

Geller 1980

(1) Salicylate and heparin gel (Dolo‐Menthoneurin)

(2) Etofenamate gel active control

Phase 1:

(1) 0/25

(2) 0/25

Phase 1:

(1) 0/25

(2) 0/25

Phase 1:

(1) 0/25

(2) 0/25

Phase 2:

(1) 0/25

(2) 0/25

Phases 1 and 2 combined:

(1) 2/50

(2) 2/50

Phases 1 and 2 combined:

(1) 2/50

(2) 2/50

Ginsberg 1987

(1) Salicylate and capsicum oleoresin ointment (Rado‐Salil)

(2) Placebo ointment

No data

No data

No data

(1) 4/20

(2) 1/20

(1) 4/20

(2) 1/20

Golden 1978

(1) Salicylate cream (Aspercreme) + placebo tablets

(2) Aspirin tablets + placebo cream active control

(1) 1/20

(2) 8/20

(1) 1/20

(2) 2/20

(1) 0/20

(2) 6/20

(1) 3/20

(2) 12/20

(1) 0/20

(2) 0/20

Ibanez 1988

(1) Salicylate spray

(2) Fepradinol spray active control

No data

No data

(1) 0/35

(2) 0/102

(1) 0/35

(2) 0/102

(1) 0/35

(2) 0/102

Lester 1981

(1) Salicylate, adrenal extract, and mucopolysaccharide gel (Movelat)

(2) Placebo gel

8/50

4 excluded due to fractures, 4 lost to follow‐up

No data

No data

(1) 0/20

(2) 2/22

(1) 0/20

(2) 2/22

Lobo 2004

(1) Salicylate cream (Theraflex‐TMJ)
(2) Placebo cream

No data

No data

No data

(1) 2/26

(2) 2/26

(1) 2/26

(2) 2/26

Rothhaar 1982

(1) Salicylate gel (Reparil‐Gel)

(2) Placebo gel

(1) 13/50

11 with no data, rest lack of efficacy

(2) 24/50

8 with no data, rest lack of efficacy

(1) 2/39

(2) 16/42

(1) 0/39

(2) 0/42

(1) 0/39

(2) 0/42

(1) 0/39

(2) 0/42

Rutner 1995

(1) Salicylate gel (Phardol‐Mono)

(2) Placebo gel

7/136

lost to follow‐up

No data

No data

(1) 1/54

unrelated disc prolapse

(2) 0/59

(1) 0/54

(2) 0/59

Shackel 1997

(1) Salicylate gel

(2) Placebo gel

(1) 15/58

14 withdrew during trial, 1 lost to follow‐up

(2) 10/58

2 withdrew before treatment, 7 withdrew during trial, 1 lost to follow‐up

(1) 3/58
(2) 2/56

(1) 10/58
(2) 1/56

(1) 48/58
(2) 29/56

Total number of adverse events:

(1) 80

(2) 27

Stam 2001

(1) Salicylate, nicotinate, capsicum oleoresin, and histamine gel (Cremor Capsici Compositus FNA)

(2) Herbal gel (Spiroflor SRL) active control

(1) 4/78

lost to follow‐up

(2) 2/83

1 death, 1 lost to follow‐up

No data

(1) 8/74

(2) 1/82

unrelated death

(1) 19/74

(2) 10/82

(1) 18/74

(2) 3/81

von Bach 1979

(1) Salicylate and nonivamide in heparin and salicylate ointment (Enelbin‐Rheuma)

(2) Salicylate in heparin and salicylate ointment active control

(1) 0/50

(2) 2/50

(1) 1/50

(2) 0/50

(1) 0/50

(2) 2/50

(1) 0/50

(2) 2/50

(1) 0/50

(2) 2/50

Wanet 1979

(1) Salicylate and myrtecaine cream (Algesal Suractive)

(2) Placebo cream

No data

No data

No data

No data

No data

Zahmatkash 2011

(1) Salicylate ointment

(2) Herbal (cinnamon, ginger, mastic, sesame oil) ointment

(1) 3/46

(2) 4/46

All lost to follow‐up

No data

No data

No data

No data

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Rubefacient versus placebo, outcome: 1.1 Clinical success (eg 50% reduction in pain).
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Rubefacient versus placebo, outcome: 1.1 Clinical success (eg 50% reduction in pain).

Forest plot of comparison: 1 Rubefacient versus placebo, outcome: 1.4 Adverse events.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Rubefacient versus placebo, outcome: 1.4 Adverse events.

Comparison 1 Rubefacient versus placebo, Outcome 1 Clinical success (eg 50% reduction in pain).
Figuras y tablas -
Analysis 1.1

Comparison 1 Rubefacient versus placebo, Outcome 1 Clinical success (eg 50% reduction in pain).

Comparison 1 Rubefacient versus placebo, Outcome 2 Adverse events.
Figuras y tablas -
Analysis 1.2

Comparison 1 Rubefacient versus placebo, Outcome 2 Adverse events.

Comparison 1 Rubefacient versus placebo, Outcome 3 Withdrawals.
Figuras y tablas -
Analysis 1.3

Comparison 1 Rubefacient versus placebo, Outcome 3 Withdrawals.

Comparison 2 Rubefacient versus active control, Outcome 1 Clinical success (eg 50% reduction in pain).
Figuras y tablas -
Analysis 2.1

Comparison 2 Rubefacient versus active control, Outcome 1 Clinical success (eg 50% reduction in pain).

Comparison 2 Rubefacient versus active control, Outcome 2 Adverse events.
Figuras y tablas -
Analysis 2.2

Comparison 2 Rubefacient versus active control, Outcome 2 Adverse events.

Comparison 2 Rubefacient versus active control, Outcome 3 Withdrawals.
Figuras y tablas -
Analysis 2.3

Comparison 2 Rubefacient versus active control, Outcome 3 Withdrawals.

Salicylate‐containing topical rubefacients compared with topical placebo for acute and chronic painful conditions

Patient or population: adults with strains or sprains (acute) or osteoarthritis or low back pain (chronic)

Settings: community

Intervention: salicylate‐containing topical rubefacient

Comparison: topical placebo

Outcomes

Probable outcome with
intervention

Probable outcome with
comparator

RR

NNT, NNTp, or NNH
(95% CI)

No of studies, participants

Quality of the evidence
(GRADE)

Comments

Clinical success (eg 50% reduction in pain)

Acute conditions

640 in 1000

335 in 1000

RR 1.9 (1.5 to 2.5)

NNT 3.2 (2.4 to 4.9)

4 studies

324 participants

⊕⊝⊝⊝
very low

Most recent, largest study showed no effect

Note NNT cannot be trusted because of low numbers and poor quality studies

Clinical success (eg 50% reduction in pain)

Chronic conditions

447 in 1000

284 in 1000

RR 1.6 (1.2 to 2.0)

NNT 6.2 (4.0 to 13)

6 studies

455 participants

⊕⊝⊝⊝
very low

Most recent, largest studies showed no effect

Note NNT cannot be trusted because of low numbers and poor quality studies

Adverse events ‐ any adverse events

Acute and chronic conditions combined

152 in 1000

94 in 1000

RR 1.6 (1.2 to 2.0)

NNH 17 (9.9 to 58)

11 studies

984 participants

⊕⊕⊝⊝
low

Inadequate reporting of adverse events is common

Acute and chronic conditions combined

Adverse events ‐ local adverse events

Acute and chronic conditions combined

56 in 1000

24 in 1000

RR 2.2 (1.1 to 4.1)

NNH 31 (16 to 300)

10 studies

869 participants

⊕⊝⊝⊝
very low

Small numbers of events

Acute and chronic conditions combined

Withdrawals ‐ lack of efficacy

Acute and chronic conditions combined

24 in 1000

72 in 1000

RR 0.4 (0.2 to 0.9)

NNTp 21 (12 to 120)

5 studies

501 participants

⊕⊝⊝⊝
very low

Small numbers of events

Acute and chronic conditions combined

Withdrawals ‐ adverse events

Acute and chronic conditions combined

49 in 1000

11 in 1000

RR 4.2 (1.5 to 12)

NNH 26 (15 to 85)

7 studies

737 participants

⊕⊝⊝⊝
very low

Small numbers of events

Acute and chronic conditions combined

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; RR: risk ratio; NNT: number needed to treat; NNTp: number needed to prevent an event happening; NNH: number needed to harm

Figuras y tablas -
Comparison 1. Rubefacient versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical success (eg 50% reduction in pain) Show forest plot

10

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Acute conditions

4

324

Risk Ratio (M‐H, Fixed, 95% CI)

1.93 [1.51, 2.46]

1.2 Chronic conditions

6

455

Risk Ratio (M‐H, Fixed, 95% CI)

1.58 [1.22, 2.04]

2 Adverse events Show forest plot

11

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Any adverse event

11

984

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [1.19, 2.04]

2.2 Local adverse events

10

869

Risk Ratio (M‐H, Fixed, 95% CI)

2.15 [1.12, 4.12]

3 Withdrawals Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Lack of efficacy

5

501

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.15, 0.87]

3.2 Adverse events

7

737

Risk Ratio (M‐H, Fixed, 95% CI)

4.19 [1.52, 11.56]

Figuras y tablas -
Comparison 1. Rubefacient versus placebo
Comparison 2. Rubefacient versus active control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical success (eg 50% reduction in pain) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Acute

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Chronic

2

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Adverse events Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Any adverse events

3

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Local adverse events

3

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Withdrawals Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Lack of efficacy

2

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Adverse events

3

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 2. Rubefacient versus active control