From the Guidelines
Alternatives to 3% diclofenac for tendinitis include other topical NSAIDs, oral NSAIDs, and physical therapy approaches, with the goal of reducing pain and inflammation while promoting healing and preventing further damage. When considering alternatives to 3% diclofenac for tendinitis, it's essential to prioritize treatments that address both pain relief and the underlying causes of tendinitis, such as overuse or improper technique.
Treatment Options
- Topical NSAIDs like 1% diclofenac (Voltaren), 5% ketoprofen, or 1.5% topical ibuprofen can be applied 3-4 times daily to the affected area 1.
- Oral NSAIDs, such as ibuprofen (400-800mg three times daily), naproxen (500mg twice daily), or celecoxib (200mg daily), are effective options for pain relief 1.
- Physical therapy approaches, including relative rest, icing, and eccentric strengthening exercises, are crucial for promoting healing and preventing further damage 1.
- For more severe cases, a short course of oral corticosteroids like prednisone (20mg daily for 5-7 days) may be considered, although their use should be cautious due to potential side effects 1.
Additional Considerations
- It's important to address the underlying cause of tendinitis to prevent recurrence, which may involve modifying activities, improving technique, or using orthotics 1.
- For persistent tendinitis, options like platelet-rich plasma injections or extracorporeal shock wave therapy might be considered, although evidence for these treatments is still emerging 1.
- Most cases of tendinitis respond well to conservative treatment within 2-3 weeks, but persistent symptoms warrant medical evaluation to rule out other conditions or to adjust the treatment plan as necessary 1.
From the FDA Drug Label
NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain
NSAID medicines that need a prescription Generic Name Trade Name Celecoxib Celebrex® Diclofenac Cataflam®, Voltaren®, ArthrotecTM (combined with misoprostol) Diflunisal Dolobid® Etodolac Lodine®, Lodine® XL Fenoprofen Nalfon®, Nalfon® 200 Flurbiprofen Ansaid® Ibuprofen Motrin®, Tab-Profen®, Vicoprofen®* (combined with hydrocodone), CombunoxTM (combined with oxycodone) Indomethacin Indocin®, Indocin® SR, Indo-LemmonTM, IndomethaganTM Ketoprofen Oruvail® Ketorolac Toradol® Mefenamic Acid Ponstel® Meloxicam Mobic® Nabumetone Relafen® Naproxen Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac® (copackaged with lansoprazole) Oxaprozin Daypro® Piroxicam Feldene® Sulindac Clinoril® Tolmetin Tolectin®, Tolectin® DS, Tolectin® 600
Alternatives to 3% diclofenac for tendinitis include:
- Ketoprofen (Oruvail®) 2
- Naproxen (Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac®) 3
- Ibuprofen (Motrin®, Tab-Profen®, Vicoprofen®)
- Indomethacin (Indocin®, Indocin® SR, Indo-LemmonTM, IndomethaganTM)
- Meloxicam (Mobic®)
- Piroxicam (Feldene®) Note that the choice of alternative should be based on the individual patient's medical condition and history. It is essential to consult a healthcare provider before starting any new medication.
From the Research
Alternatives to 3% Diclofenac for Tendinitis
- Other topical NSAIDs such as ibuprofen, ketoprofen, and piroxicam have demonstrated efficacy in providing pain relief for acute musculoskeletal pain, including tendinitis 4
- Sodium hyaluronate injections have shown consistently better results in the short and long term for overall improvement and pain reduction in lateral epicondylalgia 5
- Platelet-rich plasma injections have been proposed as a treatment for tendinopathy, but the evidence is limited and inconclusive 5, 6
- Hyaluronic acid and prolotherapy are also being investigated as potential treatments for tendinopathy, but more research is needed to determine their efficacy 6
- Oral NSAIDs such as ibuprofen may be considered as an alternative to topical diclofenac, but they may have a higher risk of systemic adverse events 4, 7
Mechanism of Action
- Topical NSAIDs, including diclofenac, work by penetrating the skin and distributing to the target tissues underlying the application site, providing localized pain relief with minimal systemic absorption 4, 8
- The effects of NSAIDs on human tendinopathic tissue are not well understood, and some studies suggest that they may not affect gene expression or lead to clear changes in tendon pain or function 7
Efficacy and Safety
- Topical NSAIDs, including diclofenac, have been shown to be effective in providing pain relief for acute musculoskeletal pain, including tendinitis, with a low risk of systemic adverse events 4, 8
- The safety and efficacy of other treatments, such as platelet-rich plasma injections and hyaluronic acid, are still being investigated and more research is needed to determine their potential as alternatives to 3% diclofenac 5, 6