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Microsoft word - nitrate_patches.doc
NITRATE TREATMENT FOR TENDONS (source: injuryupdate.com)
What are nitrate patches?
Used primarily for improving blood supply to the heart, nitrate patches have
been recently shown to improve healing in chronic tendon
injuries. Please refer to the abstracts below. Using nitratepatches for tendon injuries is currently "off-label" but is
backed by strong scientific evidence.
Are there any side effects?
Headache is the main side effect, although some people mayexperience small drops in blood pressure. Younger people tend to suffer greater
side effects with patches. These effects are minimal if 1/4 of a 5mg/24hr patchdaily is used (which can be done with the brands NitroDur and MiniTran - other
patches cannot be cut into quarters as they contain cream). For people sensitive
to the drug an even lower dose (1/8 of a patch per day) can be used to start.
The medication is incompatible (and should not
be used when taking) other
vasodilators such as Viagra, Cialis, Levitra
and similar drugs.
Topical nitric oxide application in the treatment of chronic extensor
tendinosis at the elbow: a randomized, double-blinded, placebo-
controlled clinical trial.
Paoloni JA, Appleyard RC, Nelson J, Murrell GA.
BACKGROUND: Extensor tendinosis ("tennis elbow") is a degenerative overuse
tendinopathy of the wrist extensors at their attachment to the lateral humeralepicondyle. No treatment has been universally successful. Topical application of
nitric oxide has been used effectively to treat fractures and cutaneous wounds inanimal models, presumably by stimulation of collagen synthesis in fibroblasts.
PURPOSE: To determine whether topical nitric oxide can improve outcome ofpatients with extensor tendinosis. STUDY DESIGN: Prospective, randomized,
double-blinded clinical trial. METHODS: Eighty-six patients with extensor
tendinosis were randomized into two equal groups; both were instructed toperform a standard tendon rehabilitation program. One group received an active
glyceryl trinitrate transdermal patch, and the other group received a placebopatch. RESULTS: Patients in the glyceryl trinitrate group had significantly
reduced elbow pain with activity at 2 weeks, reduced epicondylar tenderness at 6
and 12 weeks, and an increase in wrist extensor mean peak force and total workat 24 weeks. At 6 months, 81% of treated patients were asymptomatic during
activities of daily living, compared with 60% of patients who had tendonrehabilitation alone. CONCLUSIONS: Application of topical nitric oxide improved
early pain with activity, late functional measures, and outcomes of patients with
Topical glyceryl trinitrate treatment of chronic noninsertional achilles
tendinopathy. A randomized, double-blind, placebo-controlled trial.
Paoloni JA, Appleyard RC, Nelson J, Murrell GA.
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 thatmay 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: Aprospective, randomized, double-blind, placebo-controlled trial involving a total
of sixty-five patients (eighty-four Achilles tendons) was performed to comparecontinuous 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 glyceryltrinitrate 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 plantarflexor 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 withtwenty (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
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