From the Guidelines
Topical diclofenac is a viable treatment option for tendinitis, particularly for superficial tendons, as it provides modest relief with fewer systemic side effects compared to oral NSAIDs. The use of topical diclofenac for tendinitis is supported by evidence from studies on its effectiveness in reducing pain and inflammation in various forms of tendinopathy 1. Diclofenac gel (1-4%) can be applied to the affected area 3-4 times daily, with products like Voltaren gel (1% diclofenac sodium) being commonly used. The treatment duration typically ranges from 1-2 weeks, though some cases may require longer use.
Mechanism of Action
Topical diclofenac works by inhibiting prostaglandin synthesis locally, which reduces inflammation and pain at the site of application. The medication penetrates the skin to reach the inflamed tendon tissue, although its ability to reach deeper tendons may be limited. This makes it particularly effective for superficial tendons like those in the elbow (tennis elbow), wrist, or ankle.
Considerations for Use
For more severe or persistent tendinitis, combining topical treatment with rest, physical therapy, and possibly oral medications may be necessary. It is essential for individuals with aspirin allergies, asthma, or certain kidney conditions to consult a healthcare provider before using topical diclofenac. The evidence from studies such as those published in the Annals of the Rheumatic Diseases 1 supports the use of topical NSAIDs, including diclofenac, as a useful option in managing tendinopathy, especially in patients who are unwilling or unable to take oral NSAIDs.
Key Points for Treatment
- Apply diclofenac gel (1-4%) to the affected area 3-4 times daily.
- Use products like Voltaren gel (1% diclofenac sodium) with a thin layer massaged into the painful area until absorbed.
- Treatment duration typically ranges from 1-2 weeks, with possible extension for some cases.
- Combine with rest, physical therapy, and possibly oral medications for more severe cases.
- Consult a healthcare provider if the patient has aspirin allergies, asthma, or certain kidney conditions.
From the Research
Efficacy of Topical Diclofenac for Tendinitis
- The efficacy of topical diclofenac for tendinitis is not well established, with one study 2 showing no statistically or clinically significant differences between topical diclofenac and placebo in the treatment of Achilles tendinopathy.
- However, other studies have demonstrated the effectiveness of topical diclofenac in reducing pain and inflammation in various conditions, including osteoarthritis 3, 4, 5.
- A review of chronic musculoskeletal pain found that diclofenac is effective in treating nociceptive pain and chronic central pain, but its use in tendinitis is not specifically addressed 6.
Comparison to Other Treatments
- Topical diclofenac has been shown to be comparable to other topical non-steroidal anti-inflammatory drugs (NSAIDs) and some oral NSAIDs in reducing pain and inflammation 3.
- It has also been found to be effective and well-tolerated in adults, regardless of age, with fewer systemic adverse events compared to oral NSAIDs 4.
Limitations and Future Research
- The current evidence for the use of topical diclofenac in tendinitis is limited, and further research is needed to fully understand its efficacy and optimal use in this condition.
- Studies have identified gaps in knowledge regarding the time to onset of action, duration of effect, and minimum effective concentration of topical diclofenac 5.