For all tendinopathies , improvements in pain were significant when comparing GTN versus placebo in the short term ( < 8 weeks ; poor evidence ) .
Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following : patient satisfaction ( strong evidence ) ; chances of being asymptomatic with activities of daily living ( strong evidence ) ; range of movement ( moderate evidence ) ; strength ( moderate evidence ) ; pain ( at night and with activity ; poor evidence ) and local tenderness ( poor evidence ) .
Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo ( moderate evidence ) .
Conclusions and relevance Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions
Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate ( GTN ) in the treatment of tendinopathies .
Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial.
BACKGROUND Noninsertional Achilles tendinopathy is a degenerative overuse disorder . No method has been universally successful in treating this condition . Topically applied nitric oxide has been shown , in animal models , to be effective for the treatment of fractures and cutaneous wounds through mechanisms that may include stimulation of collagen synthesis in fibroblasts . The goal of the present study was to determine if topical glyceryl trinitrate improves clinical outcome measures in patients with Achilles tendinopathy . METHODS A prospect i ve , r and omized , double-blind , placebo-controlled trial involving a total of sixty-five patients ( eighty-four Achilles tendons ) was performed to compare continuous application of topical glyceryl trinitrate ( at a dosage of 1.25 mg per twenty-four hours ) with rehabilitation alone for the treatment of noninsertional Achilles tendinopathy . RESULTS Compared with the control group , the glyceryl trinitrate group showed reduced pain with activity at twelve weeks ( p = 0.02 ) and twenty-four weeks ( p = 0.03 ) , reduced night pain at twelve weeks ( p = 0.04 ) , reduced tenderness at twelve weeks ( p = 0.02 ) , decreased pain scores after the hop test at twenty-four weeks ( p = 0.005 ) , and increased ankle plantar flexor mean total work compared with the baseline level at twenty-four weeks ( p = 0.04 ) . Twenty-eight ( 78 % ) of thirty-six tendons in the glyceryl trinitrate group were asymptomatic with activities of daily living at six months , compared with twenty ( 49 % ) of forty-one tendons in the placebo group ( p = 0.001 , chi-square analysis ) . The mean effect size for all outcome measures was 0.14 . CONCLUSIONS Topical glyceryl trinitrate significantly reduced pain with activity and at night , improved functional measures , and improved outcomes in patients with Achilles tendinopathy
For all tendinopathies , improvements in pain were significant when comparing GTN versus placebo in the short term ( < 8 weeks ; poor evidence ) .
Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following : patient satisfaction ( strong evidence ) ; chances of being asymptomatic with activities of daily living ( strong evidence ) ; range of movement ( moderate evidence ) ; strength ( moderate evidence ) ; pain ( at night and with activity ; poor evidence ) and local tenderness ( poor evidence ) .
Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo ( moderate evidence ) .
Conclusions and relevance Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions
Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate ( GTN ) in the treatment of tendinopathies .