Medically reviewed by: Dr Steve Andrews, MBBS FRACS FAOrthA MCIME (ABIME)
Muscle and joint pain is extremely common in older Australians and is a major contributor to reduced mobility, poor sleep, and loss of independence (Australian Institute of Health and Welfare [AIHW], 2023, 2024). Best-practice care usually combines exercise, physical therapy, appropriate medicines, and person-centred support, rather than relying on any single treatment (Royal Australian College of General Practitioners [RACGP], 2015; Australian Pain Society, 2024).
TGA-listed topical medicines such as warming and cooling creams or gels may provide temporary relief of mild muscle and joint aches when applied to intact skin and used exactly as directed. In this context:
- Rygg HEATE® is a TGA-listed warming topical medicine used to decrease, reduce or relieve mild joint aches and pains, and to help enhance or improve muscle performance, endurance and stamina when used as directed.
- Rygg KHULE® is a TGA-listed cooling topical medicine used to decrease, reduce or relieve mild joint inflammation and swelling, help reduce or relieve symptoms of muscle sprain and strain, and aid post-exercise recovery when used as directed.
In both residential aged care and at home, these products should be viewed as small adjuncts within a broader care plan, not stand-alone treatments for complex conditions such as osteoarthritis, chronic widespread pain, or pain in advanced dementia (RACGP, 2015; Australian Pain Society, 2024). Always read the label and follow the directions for use.
1. How common is muscle and joint pain in older Australians?
Musculoskeletal conditions and chronic pain are highly prevalent in older Australians and often cluster with multimorbidity. National data suggest:
- In 2017–18, around 49% of Australians aged 65 and over reported being diagnosed with arthritis, most commonly osteoarthritis (AIHW, 2023).
- Across all ages, about 29% of Australians live with chronic musculoskeletal conditions such as back problems, arthritis or osteoporosis (AIHW, 2024).
- International and Australian estimates indicate that 20–30% of older adults experience chronic pain, often of musculoskeletal origin, with higher rates among those in residential aged care (Gilmartin-Thomas et al., 2020; Australian Pain Society, 2024).
- Among people living with dementia in residential care, 60–80% experience regular pain, frequently under-recognised and undertreated (Australian Pain Society, 2024).
In Australian residential aged care facilities (RACFs), musculoskeletal pain (for example from osteoarthritis, low-back pain or prior injuries) is the predominant cause of pain (RACGP, 2015). The Australian Pain Society highlights that older adults are particularly vulnerable to unresolved pain yet may under-report symptoms because they:
- Believe pain is “just part of getting older”,
- Worry about the side effects of medicines, or
- Have communication difficulties, including in the context of cognitive impairment (Australian Pain Society, 2024).
This context explains why clinicians look for multi-modal strategies, including topical medicines, that can be layered with movement, sleep support, and safe systemic analgesics to improve comfort and function.
2. Principles of pain management in aged care
High-quality pain management in aged-care settings is typically:
- Multidimensional – addressing physical, psychological, and social contributors to pain.
- Interdisciplinary – involving GPs, nurses, pharmacists, physiotherapists, occupational therapists, and when required, geriatricians and pain specialists.
- Individualised – tailored to meaningful functional goals: walking to the dining room, participating in group physiotherapy, or sleeping through the night (RACGP, 2015; Australian Pain Society, 2024).
Common components include:
2.1 Non-pharmacological strategies
- Graded exercise and strength/balance training, often supervised by physiotherapists or exercise physiologists.
- Heat or cold packs, repositioning, supportive footwear, and mobility aids.
- Occupational therapy to optimise joint protection, safe transfers, and independence in daily activities.
2.2 Pharmacological options
- Simple analgesics such as paracetamol as first-line for many older adults, with attention to dosing schedules and liver function.
- Topical NSAIDs and, where appropriate, short courses of oral NSAIDs, used cautiously because of gastrointestinal, renal and cardiovascular risks (Marcum et al., 2016; RACGP, 2018).
- Opioids only where clearly indicated, at the lowest effective dose and with regular review due to risks of sedation, falls, constipation, and dependence (Marcum et al., 2016).
2.3 Topical treatments
- Heat packs, warm showers, or cold packs used intermittently and with skin protection.
- TGA-listed topical medicines such as menthol- and/or methyl salicylate–containing creams or gels (for example, Rygg HEATE® and Rygg KHULE®) for temporary relief of mild muscle and joint aches, applied strictly according to label directions (Mansour et al., 2024).
2.4 Regular assessment and review
- Use of validated pain assessment tools, including observational tools (e.g., behaviour-based scales) for residents with dementia or communication difficulties (Australian Pain Society, 2024).
- Scheduled review of pain, function and medicines, with deprescribing where treatments no longer provide benefit.
Within this framework, topical medicines are best viewed as adjunctive, local symptom-relief tools, rather than primary treatments or substitutes for guideline-based disease management.
3. Where topical pain-relief creams and gels can help
Evidence for topical rubefacients and other topical analgesics in musculoskeletal pain indicates that they can provide modest, short-term symptom relief for some people, often with lower systemic exposure than oral analgesics (Mansour et al., 2024; Marcum et al., 2016).
For older adults, potential advantages include:
- Localised effect: creams and gels can be applied directly over joints or muscle groups that are particularly uncomfortable after everyday activity.
- Reduced systemic exposure: compared with many oral agents, topical medicines can limit systemic drug levels, which is important in older adults with polypharmacy and organ impairment (Mansour et al., 2024).
- Flexible timing around activity: for example, applying a warming cream before gentle exercise, or a cooling gel after a walk, can be integrated with physio-led programs.
However, there are also clear limitations and cautions:
- The magnitude of pain relief is often modest, and responses vary between individuals. Topicals are not a cure for osteoarthritis or chronic pain syndromes (Mansour et al., 2024).
- Skin reactions (redness, irritation, dermatitis) can occur, and older, thinner or sun-damaged skin may be more vulnerable (American Academy of Dermatology [AAD], 2021).
- Topicals must not be applied over broken skin, pressure injuries, ulcers or active dermatological conditions, which are common in frail elders (RACGP, 2015).
A conservative, aged-care-appropriate description of TGA-listed products such as Rygg HEATE® and Rygg KHULE® is therefore:
“Topical medicines for the temporary relief of mild muscle and joint aches, applied to intact skin and used exactly as directed, as one part of a broader pain-management plan agreed with the care team.”
4. Rygg HEATE® and Rygg KHULE™: TGA-listed indications in context
Within this broader framework, Rygg’s topical products can be positioned in plain, TGA-consistent language that accurately reflects their ARTG-listed indications.
4.1 Rygg HEATE® (warming)
Rygg HEATE® is a TGA-listed warming topical medicine used to:
- Decrease, reduce or relieve mild joint aches and pains, and
- Help enhance, improve, promote or increase muscle performance, endurance and stamina, when applied to intact skin and used as directed.
In an aged-care context, this does not mean HEATE™ is a performance-enhancing drug or a treatment for osteoarthritis. Instead, it can be described as:
- A warming cream that temporarily relieves mild joint aches and pains, and
- May help some older adults feel more comfortable and confident when performing prescribed strength, balance or walking exercises, potentially enabling them to complete sessions that support mobility and independence.
4.2 Rygg KHULE® (cooling)
Rygg KHULE® is a TGA-listed cooling topical medicine used to:
- Decrease, reduce or relieve mild joint inflammation and swelling,
- Help decrease, reduce or relieve symptoms of muscle sprain and strain, and
- Aid post-exercise recovery, when used as directed on intact skin.
For older adults, KHULE™ can be positioned as:
- A cooling gel that provides temporary relief of mild joint inflammation and swelling, for example after increased activity or a minor sprain or strain that has been assessed by a clinician;
- A post-exercise option to aid recovery from gentle walking programs, physiotherapy sessions or resistance training, by supporting comfort after activity.
In all cases, messaging should emphasise:
- External use only;
- Intact skin only;
- Avoiding eyes, mouth, mucous membranes and genital area;
- Stopping use if irritation develops; and
- Consulting a health professional for persistent, severe or function-limiting pain.
5. Practical use in residential aged care
Introducing topical medicines into RACFs requires clear protocols and good communication between prescribers, nurses, care staff and families. A typical, label-aligned process might include:
5.1 Clinical decision and documentation
- A GP or nurse practitioner confirms that a warming or cooling topical medicine (e.g., Rygg HEATE® or Rygg KHULE®) is appropriate for a resident with mild musculoskeletal symptoms and no contraindications.
- The product name, indication (e.g., “mild joint aches”, “symptoms of minor muscle strain”), anatomical sites, and frequency are clearly documented in the medication chart or care plan.
5.2 Skin assessment
- Nursing or care staff assess the skin at the intended application site for integrity, bruising, pressure injury, rashes, or signs of infection.
- Products are applied only to intact skin; areas with dressings, ulcers, tears or dermatological conditions are excluded (RACGP, 2015).
5.3 Application technique
- A thin layer of cream or gel is applied to the prescribed area, more is not better.
- Staff avoid sensitive areas and wash hands after application or wear gloves.
- Clothing, compression garments and continence products are replaced only after the product has dried, to reduce the risk of maceration and irritation (AAD, 2021).
5.4 Frequency and monitoring
- Directions on the pack (for example, “up to X times per day”) are followed precisely; applications are recorded.
- Staff monitor for benefit (e.g., improved willingness to mobilise) and any adverse effects (redness, blistering, new rash), documenting and reporting concerns promptly.
- Pain scores, behaviour charts and functional goals are reviewed regularly, and topical use is adjusted or discontinued if no meaningful benefit is observed.
5.5 Communication with families
- Families are informed that Rygg HEATE® and KHULE™ are symptom-relief medicines, not cures for arthritis or causes of “addiction”.
- The care team emphasises that maintaining movement, physiotherapy engagement and social participation remain core strategies for preserving function and quality of life in older age (RACGP, 2015; Australian Pain Society, 2024).
6. Sensitive skin, patch testing and “hypoallergenic” language
Many older adults have thin, dry or sun-damaged skin, may be taking medicines such as corticosteroids or anticoagulants, and may have a history of eczema or contact dermatitis (AAD, 2021). For this reason:
- No topical medicine can be labelled as completely “non-allergenic”.
- It is safer to use phrasing such as:
- “Formulated for use on intact skin, with a non-greasy feel that is usually well tolerated in most adults.”
- “People with sensitive skin should patch test a small area first and discuss any concerns with their health professional.”
A simple patch-testing approach is consistent with dermatology guidance (AAD, 2021):
- Apply a pea-sized amount of Rygg HEATE® or Rygg KHULE® to a small area of intact skin (e.g., forearm).
- Leave for 24–48 hours, avoiding washing that area.
- Observe for redness, itching, swelling or discomfort.
- If a reaction occurs, the product should not be used more widely and alternatives should be discussed with a clinician.
7. At-home topical pain relief for older Australians and carers
Outside RACFs, many older Australians manage mild muscle and joint aches at home, often with informal support from family carers. A simple, TGA-aligned routine might look like:
7.1 Daily movement
- Short walks, chair-based strength work, and balance exercises tailored by a physiotherapist or exercise physiologist help maintain function and reduce falls risk (RACGP, 2018).
- For some older adults, applying Rygg HEATE® to mildly aching joints or muscles before exercise may make it more comfortable to start moving, within the boundaries of their care plan.
7.2 Optional topical use around activity
- A warming cream such as HEATE™ can be used before gentle activity to help relieve mild joint aches and support muscle performance and endurance, as listed on the ARTG.
- A cooling gel such as KHULE™ can be applied after a walk, gardening, or prescribed exercises to help decrease mild joint inflammation and swelling, relieve symptoms of minor sprain or strain, and aid post-exercise recovery.
- In all cases, products are used on intact skin only, in thin layers, within the maximum daily applications specified on the label.
7.3 Sleep and comfort
- Comfortable bedding, pillows and positioning aids can reduce night-time pain flares.
- Relaxation strategies, regular sleep–wake times, and minimising caffeine and alcohol also support pain management.
7.4 When to seek review
Carers and older adults should seek medical review if:
- Pain is new, severe or rapidly worsening,
- Pain is associated with fever, unexplained weight loss, or night sweats,
- There is a sudden loss of function (e.g., an independent person becomes unable to mobilise), or
- Pain continues to limit basic activities despite appropriate self-care and short-term use of topical medicines (RACGP, 2015; Australian Pain Society, 2024).
8. TGA compliance checkpoints for Australian messaging
To remain aligned with the Therapeutic Goods Advertising Code, Australian-facing content about Rygg HEATE® and Rygg KHULE® should:
- Use indications consistent with their ARTG entries, such as:
- “Decrease/reduce/relieve mild joint aches and pains” and
- “Helps enhance/improve/promote/increase muscle performance/endurance/stamina” for HEATE™;
- “Decrease/reduce/relieve mild joint inflammation/swelling”,
- “helps decrease/reduce/relieve symptoms of muscle sprain/strain”, and
- “aid/assist post-exercise recovery” for KHULE™, always with the caveat “when used as directed.”
- Avoid disease-treatment claims, such as “treats osteoarthritis” or “controls chronic pain”, and instead refer to “mild muscle and joint aches” or “symptoms of muscle sprain/strain.”
- Avoid implying that topical medicines can replace prescribed disease-modifying treatments or professional care.
- Include clear safety cues:
- External use only;
- Intact skin only;
- Stop use if irritation develops;
- Keep out of reach of children;
- Seek medical advice for persistent, severe or function-limiting pain.
- Encourage older adults and carers to involve their GP, pharmacist or care team when integrating topical medicines into a broader pain-management plan.
9. Conclusion
Muscle and joint pain is common in older Australians and can profoundly affect mobility, sleep, and independence, especially in residential aged care. High-quality pain care in this population is multifaceted and team-based, combining movement, psychosocial support, and carefully chosen medicines.
Within this broader context, Rygg HEATE® and Rygg KHULE® offer TGA-listed topical options that:
- Provide temporary relief of mild joint aches and pains, mild joint inflammation and swelling, and symptoms of minor sprain and strain, and
- Can support participation in exercise and post-exercise comfort when used as directed on intact skin.
They do not treat or cure arthritis or chronic pain, and they cannot substitute for proper assessment and guideline-based management. Used thoughtfully, with attention to skin health, communication, and red-flag symptoms, topical medicines can be one small but meaningful piece of a person-centred pain plan that prioritises mobility, safety and dignity for older Australians.
Always read the label and follow the directions for use.
References (APA)
American Academy of Dermatology. (2021). How to test skin care products at home.
Australian Institute of Health and Welfare. (2023). Arthritis, 2022. AIHW.
Australian Institute of Health and Welfare. (2024). Chronic musculoskeletal conditions. AIHW.
Australian Pain Society. (2024). Position statement: Pain management in aged care. Australian Pain Society.
Gilmartin-Thomas, J. F. M., et al. (2020). Musculoskeletal pain on most days in older adults. Pain Medicine.
Mansour, D. Z., Nguyen, B. T., & Brandt, N. J. (2024). Over-the-counter topical analgesics: Benefits and risks for older adults. Topics in Pain Management, 40(3), 1–7.
Marcum, Z. A., et al. (2016). Pharmacotherapies in geriatric chronic pain management. Clinics in Geriatric Medicine, 32(4), 705–724.
Royal Australian College of General Practitioners. (2015). Pain management in residential aged care facilities. Australian Family Physician, 44(4), 198–203.
Royal Australian College of General Practitioners. (2018). Guideline for the management of knee and hip osteoarthritis (2nd ed.). RACGP.