UBC Theses and Dissertations
Randomized controlled trial to evaluate the effects of topical diclofenac on the pain associated with chronic Achilles tendinopathy : a pilot study Bussin, Erin Rebecca
Background: Exercise-based rehabilitation for chronic Achilles tendinopathy (CAT) has proven to be effective, but it can be a painful process. The purpose of this research is to see if a topically applied non-steroidal anti-inflammatory drug, diclofenac, will be able to relieve the pain associated with chronic tendinopathy. The effects of diclofenac on subjects’ pain and mechanical hyperalgesia will be evaluated at rest and during simple calf exercises. It is expected that diclofenac will reduce pain among subjects with Achilles tendinopathy. Methods: 19 subjects (22 Achilles) with CAT were randomly assigned to a crossover treatment order (active gel containing 10% diclofenac, or placebo). The primary outcome measure was pain level during tendon loading (hopping) and at rest. The secondary outcome measures evaluated tendon loading characteristics, and mechanical hyperalgesia over the lesion, and over the bilateral trapezius muscles. Results: Pain was significantly reduced from baseline with the use of diclofenac during tendon loading (p=0.0003) and rest (p=0.0313). At baseline the average resting pain was 3.05 (+/-1.43), with the use of diclofenac the pain was 2.32 (+/- 1.52), and with the use of placebo the pain was 2.68 (+/- 2.03). At baseline the average hopping pain was 4.82 (+/-2.1), with the use of diclofenac the average hopping pain was 3.05 (+/-1.81), and with the use of placebo the average pain was 3.77 (+/-2.76). During the hopping test, subjects were able to generate significantly more force when experiencing less pain (p<0.0001). The pressure pain threshold at the Achilles tendon was significantly increased from baseline with diclofenac treatment (p = 0.0275). There was no statistically significant difference between the diclofenac and placebo treatment in all cases. Conclusion: Diclofenac was able to improve symptoms and reduce pain during tendon loading and rest in subjects with CAT. Future studies can look at using topical diclofenac with loading exercises to build a more effective and tolerable rehabilitation program while determining the potential clinical significance of diclofenac vs placebo treatment. The pressure pain threshold at the Achilles tendon and distant regions should be further investigated to gain a better understanding of the pain mechanisms involved with this disorder.
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