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The answer is unknown, but both topical agents appear effective. Topical NSAIDs provide a 50% reduction in acute musculoskeletal pain about 1.3 to 1.6 times more often than placebo (SOR: A, meta-analysis of RCTs). Although not evaluated for acute musculoskeletal pain, topical lidocaine patches provide at least a 50-point reduction in pain on a 100-point scale in patients with myofascial pain syndrome (SOR: B, RCT). The lack of head-to-head comparisons precludes determining which treatment is better.