Review article (meta-analysis)Evidence on the Effectiveness of Topical Nitroglycerin in the Treatment of Tendinopathies: A Systematic Review and Meta-Analysis
Section snippets
Criteria for Considering Studies for This Review
Studies were considered eligible for inclusion in this review if they were clinical control trials or RCTs comparing topical nitroglycerin intervention with a placebo intervention, a controlled comparison intervention, or standard care (defined as a treatment option that is normally given).
Participants
Inclusion in this review was restricted to trials with participants meeting the following criteria: (1) adult subjects (>18y of age); (2) any nationality or race; (3) presence of pain as an outcome measure;
Study Inclusion
The search of the literature yielded a total of 163 published articles. No unpublished manuscripts were identified. Of the 163 published articles, 7 were considered potentially relevant, derived from the following databases: PubMed,8, 10, 11, 12, 14 Turning Research Into Practice,9 and ScienceDirect.13 The remaining 156 articles were outrightly rejected because they were non-RCTs (1 review article, 70 descriptive studies, 48 case reports, 25 case series, 1 retrospective study, 11 prospective
Discussion
Individually, all 5 placebo-controlled studies8, 9, 10, 11, 13 reported analgesic effects of topical nitroglycerin beyond a placebo response. One study,14 however, reported no significant difference on pain reduction compared with the control group. At present, there is still limited evidence to support the role of topical nitroglycerin in improving outcomes for acute and subacute tendinopathies. This is primarily due to the inadequacy of relevant RCTs. In the acute phase, only 1 study
Conclusions
The results of this review provide fairly strong evidence for the effectiveness of nitroglycerin in pain reduction in activities of daily living for chronic tendinopathies as compared with placebo. There are many promising advantages of using topical glyceryl nitrates in tendinopathies. These include increased compliance, because it is easily applied and is relatively more economical than other treatment alternatives. Furthermore, it may potentially reduce the risk of more invasive management
References (20)
Oxygen free radicals and tendon healing
J Shoulder Elbow Surg
(2007)Gammadelta T-cells: potential regulators of the post-burn inflammatory response
Burns
(2009)- et al.
Transdermal nitroglycerin versus corticosteroid infiltration for rotator cuff tendinitis
Aten Primaria
(2001) - et al.
Successful treatment of shoulder pain syndrome due to supraspinatus tendinitis with transdermal nitroglycerinA double blind study
Pain
(1996) - et al.
Tendon pathology and injuries: pathophysiology, healing, and treatment considerations
- et al.
Common overuse tendon problems: a review and recommendations for treatment
Am Fam Physician
(2005) - et al.
Treatment of lateral epicondylitis
Am Fam Physician
(2007) Basic and clinical pharmacology
Using nitric oxide to treat tendinopathy
Br J Sports Med
(2007)- et al.
Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy: a randomized, double-blinded, placebo-controlled clinical trial
Am J Sports Med
(2005)
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2013, Primary Care - Clinics in Office PracticeCitation Excerpt :Even though there is no histologic confirmation, these results suggest that treatment with exogenous NO not only has an effect on pain control but also in tendon healing. In 2010, Gambito and colleagues57 published a meta-analysis identifying 7 randomized clinical trials looking at the effects of topical nitroglycerin in the treatment of tendinopathies. The analysis revealed that topical nitroglycerin provides short-term pain relief to a maximum of 6 months in ADLs in acute and chronic tendinopathies.
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