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 The study team focused on overuse tendon injuries in the shoulders,
wrists, heels and knees that are often caused by sports or
repetitive physical tasks and can lead to pain, swelling and limited
mobility. Depending on its severity, the condition may be treated
with physical therapy, corticosteroid injections to provide
short-term pain relief or surgery to repair or replace damaged
tendons.
The current study examined another treatment option, nitroglycerin
patches placed on the skin, which can have fewer side effects than
injections or surgery, said senior author Neal Millar of the
University of Glasgow in Scotland. While topical nitroglycerin has
been examined for tendon pain for more than two decades, research to
date has offered a mixed picture of how well it works for this
purpose, Millar said.
To get a better look at the effectiveness of this option, Millar and
colleagues analyzed data combined from 10 smaller clinical trials
that randomly assigned some patients with tendon pain to use
nitroglycerin patches and others to an alternative treatment or to a
placebo, or dummy, patch.
After six months of treatment, topical nitroglycerin provided more
pain relief than a placebo, Millar's team reports in the British
Journal of Sports Medicine.
"This matters for patients because all other current pharmacological
and injection therapies have failed to produce convincing results to
improve patient care," Millar said by email.
Up to one in five patients can suffer headaches from the topical
treatment, and some also experienced stinging where the patches were
placed, the analysis found.
Based on these results, it may make sense for patients to consider
using patches in conjunction with physical therapy in initial
efforts to relieve tendon pain, Millar said.
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Over 12 to 24 months, however, the patches didn't appear to affect
pain when people were at rest. Longer-term use was still associated
with better strength and range of motion in some instances.
One limitation of the analysis is that researchers didn't pool data
across all of the smaller studies to examine exactly how much better
patches might be than a placebo. It's also not clear if this
approach would be ideal for all types of tendon injuries in all
parts of the body.
Patients might also get topical nitroglycerin gels or ointments,
which were not examined in the current study focused on patches.
Even so, the results suggest that patches may be a viable option for
some patients, said Dr. Selene Parekh of the North Carolina
Orthopedic Clinic and Duke University in Durham, North Carolina.
"The benefits are better than placebo and seem to help patients
restore activities of daily living," Parekh, who wasn't involved in
the study, said by email.
Some patients who get headaches from the patches may also be able to
continue using them by cutting the dose, noted Dr. George Murrell of
the University of New South Wales in Sydney, Australia.
"The treatment for this headache is to cut the patch into smaller
pieces, i.e. use a smaller dose," Murrell, who wasn't involved in
the study, said by email.
SOURCE: https://bit.ly/2OHzwRe British Journal of Sports Medicine,
online October 9, 2018.
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