If you’ve ever taken a hard fall on the ice, worked out a little too hard at the gym, or felt daunted by your returning arthritis on cold winter days, you may have thought of using Rub-A535®. Many people slather on Rub-A535® to provide a “tingly relief” sensation when their joints or muscles are causing them pain. The question is, does Rub-A535® actually help
What is Rub-A535® and how does it work?
Rub-A535® is a topical analgesic (pain reliever) designed to decrease muscle pain. It comes in many different forms including lotions, gels, rub-on sticks, and medicated wraps2. It typically costs between $10 and $202. Rub-A535® formulations target muscle stiffness and soreness typically from physical activity and arthritis3.
The ingredients used in most formulations have been used individually to reduce muscle pain3. The wide variety of products contain many different medicinal ingredients, but the most common ingredients are:
- methyl salicylate (12.5%-21%): is absorbed into the skin and converted by the body into salicylic acid. The release of salicylic acid leads to a reduction in the molecules contributing to pain sensations. This process helps relieve muscle pain, but may take up to 8 hours4.
- capsaicin (<1%): stimulates the nerves in the skin responsible for pain. This stimulation masks the pain in the muscles by providing a burning sensation to the nerves5. This tingling and burning sensation can take your mind off the pain until the capsaicin wears off5.
- menthol/camphor (1%-4%): stimulate the nerves in the skin by masking the pain with a cooling effect6,7. Many people find this cooling sensation to provide relief on muscle and joint pain, and cause muscle relaxation. Although menthol can be cooling, it does not have a direct effect on the pain and inflammation in the muscles6.
What does the evidence say?
There is no strong evidence on the rub itself so we will look at some studies done on the individual components in Rub-A535®.
- Methyl salicylate: has been approved by Health Canada for temporary pain relief of stiff and sore muscles; however, little evidence supports its efficacy7. In 2004, a study found evidence that salicylate creams may reduce pain, but are only moderately effective for muscular, skeletal, and arthritic pain8. In 2010, another study found that participants who wore patches containing 10% methyl salicylate and 3% menthol (comparable to concentrations in Rub-A535®) had a significant reduction in mild to moderate muscle strain compared to those who didn’t wear the patch9.
- Camphor: is likely effective in reducing muscular pain in concentration from 3%-11% (resembling concentration in Rub-A535®) from The Natural medicines comprehensive database (NMCD)10. The NMCD also suggests that there is not enough evidence to support menthol’s efficacy in reducing inflammation and local pain11. However, Health Canada has approved camphor and menthol for the relief of muscle pains7.
- Capsaicin: has varying data on its effects for pain relief in creams at a low dose (<1%). There were only two studies suggesting that capsaicin may relieve muscle pain and were not reliable12. Furthermore, evidence suggests that there is insufficient data to draw conclusions on low dose capsaicin creams for the treatment of nerve pain12.
Most muscle rubs for pain relief have limited evidence, and they all seem to have similar effects on pain. Therefore, when choosing a product it often comes down to personal preference17.
How safe is Rub-A535®?
Rub-A535® cream is typically considered safe as the active ingredients generally do not get absorbed into the bloodstream. Topical applications of the cream work locally and have less side effects, especially compared to oral pain relievers13. Skin irritation is one mild side effect that users may experience7. Rub-A535® has been known to cause mild to severe burns if used too much or inappropriately14. To help prevent this skin irritation, it is important to avoid applying the rub on broken skin, wounds, or thin skin (genital area and face)15. If you experience any skin irritation, swelling, or burning, discontinue using this product. Methyl salicylate can also interact with blood thinners such as Aspirin or Warfarin; therefore, concurrent use of these two products should be avoided16. Health Canada has reported serious complications if this product is swallowed, so it is important to keep out of reach from small children7. Do not use Rub-A535® if you are allergic to any of the contents in the formulations as hypersensitivity reactions have been reported3. Even though the side effects of muscle rubs are usually mild, it is always recommended that you talk to your pharmacist or doctor before starting any new therapies.
Bottom Line: Can Rub-A535® rub away the pain?
Rub-A535® may be effective in improving mild muscle pain for a short period of time, but the evidence isn’t strong for severe, ongoing pain. It is important to remember that painful muscle aches that have you limping require medical attention. However, if you are experiencing some mild aches and pains, Rub-A535® may be an easy-to-use, safe option to try when used properly. At the very least, you might enjoy the tingles!
Nicole Gaudet, Priya Samuel, Stephanie Metzger, and Jillian Breen
BSc. Pharm Candidate(s)
Faculty of Pharmacy and Pharmaceutical Sciences
University of Alberta
Edited and Reviewed by the Health Aisle Team
- Nosaka, K. (2008). Muscle Soreness and Damage and the Repeated-Bout Effect. In Skeletal Muscle Damage and Repair. Retrieved from http://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2001&context=ecuworks
- Canada’s #1 Heat Analgesic Rub | RUB·A535®. (n.d.). Retrieved from http://ruba535.com
- e-CPS. Rub A-535 Antiphlogistine Drug Monograph. Retrieved April 23, 2015 from https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=methyl%20salicylate&simpleIndex=brand_generic&simpleQuery=methyl%20salicylate#m491625n00016
- Green, B. G., & Flammer, L. J. (1989). Methyl salicylate as a cutaneous stimulus: a psychophysical analysis. Somatosensory & Motor Research, 6(3), 253-274.
- Anger, W. H. (2014). Low-concentration topical capsaicin for chronic neuropathic pain in adults. Clinical Journal Of Oncology Nursing, 18(1), 123-124.
- Peier, A. M., Moqrich, A., Hergarden, A. C., Reeve, A. J., Andersson, D. A., Story, G. M., & … Patapoutian, A. (2002). A TRP channel that senses cold stimuli and menthol. Cell, 108(5), 705-715.
- Health Canada: Drugs and Health Products. (2015). Counterirritants. Retrieved from http://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=counter
- Mason, L., Moore, R. A., Edwards, J. E., McQuay, H. J., Derry, S., & Wiffen, P. J. (2004). Systematic review of efficacy of topical rubefacients containing salicylates for the treatment of acute and chronic pain. BMJ Clinical Research Ed., 328 (7446), 995.
- Higashi, Y., Kiuchi, T., & Furuta, K. (2010). Efficacy and safety profile of a topical methyl salicylate and menthol patch in adult patients with mild to moderate muscle strain: a randomized, double-blind, parallel-group, placebo-controlled, multicenter study. Clinical Therapeutics, 32(1), 34-43.
- Natural Medicines. (2014). Camphor product monograph. Retrieved from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=709
- Natural Medicines. (2014). Peppermint product monograph. Retrieved from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=705
- Derry, S., & Moore, R. A. (2012). Topical capsaicin (low concentration) for chronic neuropathic pain in adults. The Cochrane Database Of Systematic Reviews.
- Martin, D., Valdez, J., Boren, J., & Mayersohn, M. (2004). Dermal absorption of camphor, menthol, and methyl salicylate in humans. Journal Of Clinical Pharmacology, 44(10), 1151-1157.
- S. Food and Drug Association. (2012). FDA Drug Safety Communication: Rare cases of serious burns with the use of over-the-counter topical muscle and joint pain relievers. Retrieved from http://www.fda.gov/Drugs/DrugSafety/ucm318858.htm
- Mayo Clinic. (2013). Arthritis pain: Treatments absorbed through your skin. Retrieved from http://www.mayoclinic.org/diseases-conditions/osteoarthritis/in-depth/pain-medications/
- Yip, A. S., Chow, W. H., Tai, Y. T., & Cheung, K. L. (1990). Adverse effect of topical methyl salicylate ointment on warfarin anticoagulation: an unrecognized potential hazard. Postgraduate Medical Journal, 66(775), 367–369.
- Jorge, L. L., Feres, C. C., & Teles, V. E. (2011). Topical preparations for pain relief: efficacy and patient adherence. Journal of Pain Research, 4, 11–24.