Transdermal nitroglycerine treatment of shoulder tendinopathies in patients with spinal cord injuries

Abstract

Study design: A clinical blind study was conducted to determine the efficacy of transdermal nitroglycerine treatment on the awareness of shoulder pain. Objective: This study aims to determine the effects of transdermal nitroglycerine on shoulder pain and on functional shoulder movement in patients with spinal cord injuries and shoulder tendinopathies. A second aim is to establish the side effects of the treatment. Setting: Hospital ''La Fe'' in Valencia, Spain. Methods: A total of 45 spinal cord injury patients, all of whom are wheelchair users with shoulder tendinopathy, were randomly divided into two groups: placebo (n ¼ 12) and experimental (n ¼ 33). The experimental group (EG) received transdermal treatment for 6 months in the form of a 1.25 mg nitroglycerine (NT) patch on the greater tubercle. A placebo patch was used with the placebo subjects. Functional shoulder movements were assessed by articular range of motion and pain, using a visual analogical scale. Results: NT treatment reduced the awareness of shoulder pain and increased the functional movement and range of articular motion in the shoulders of the EG members (Po0.05). Conclusions: We conclude that transdermal NT is an efficient method for treating shoulder tendinopathies in wheelchair users with spinal cord injuries.

An interactive 3-D application for pain management: Results from a pilot study in spinal cord injury rehabilitation

“…However, nociceptive pain may arise due to specific joint or musculoskeletal pains e.g. shoulder pain from self-propelling a wheelchair [5,6,7], generalized pain related to the discomfort of sitting in a wheelchair for prolonged periods of time [8], or visceral pain e.g. related to sphincter dysfunction [9].…”

Glyceryl trinitrate patches—An alternative treatment for shoulder impingement syndrome

“…The participants were randomly assigned to an experimental group ( n = 33) and a placebo group ( n = 12), each respectively administered a quarter (1.25 mg) GTN patch or placebo patch daily, on the lateral aspect of the shoulder. This treatment pattern was maintained for over 6 months in absence of additional pharmacotherapy or physical therapy [14] .…”

“…It is considered a “safe” treatment, due to the absence of severe or chronic adverse events, with symptoms primarily constituting of headaches and mild rash, characterised by their “reversal upon cessation” nature [9] . The administrating dosage can be titrated simply to facilitate the treatment intention, in the context of the clinical trials below a 5 mg/24-hour patch is subdivided into equal quarterly 1.25 mg/24-hour patches, replaced daily [14] .…”

“…Giner-Pascual et al [14] conducted a double-blinded clinical trial evaluating the efficacy of transdermal GTN patches in treating shoulder pain and functionality, in 45 wheel-chair-bound spinal cord injury patients presenting with concurrent shoulder tendinopathy. Diagnosis of rotator cuff tendinitis or partial tears was made based on magnetic resonance imaging findings (or ultrasonography when magnetic resonance imaging was contraindicated), in concordance with the complaint of chronic shoulder pain (> 3 months) prior to inclusion in the study.…”

Kroniske smerter etter ryggmargsskade

“…Målrettede treningsprogrammer har vaert effektive i fire studier på skuldersmerter (60 -63). Transdermal glyseroltrinitrat har vist effekt ved nociseptive skuldersmerter (64).…”