The effectiveness of topical diclofenac for lateral epicondylitis

Introduction: Gastrointestinal upset and local pain commonly limit the use of oral nonsteroidal anti-inflammatory drugs and corticosteroid injection a s treatments for lateral epicondylitis. Transdermal administration of an an ti-inflammatory drug could avoid these adverse effects. Purpose: To determine the effectiveness of topical diclofenac as a treatmen t of lateral epicondylitis. Methods: A convenience sample of 14 subjects meeting clinical criteria of c hronic lateral epicondylitis participated in this randomized, double blind, crossover study. Each subject applied a pluronic lecithin liposomal organo -gel (PLO) over the affected lateral elbow three times daily for 1 week. fo llowed by a 1-week "washout" period of no gel. A second topical PLO gel was then applied similarly for 1 week. Both gels were identical. but only one gel contained 2% diclofenac. Treatment order was randomized, and both the s ubject and tester were blinded, Pain and isometric wrist extension strength were measured using a visual analog pain scale (VAS) and a mounted manual muscle testing dynamometer, respectively, at the following time periods: ju st before application of the first gel, the last day of using the first gel , the last day of the washout week, and the last day of using the second ge l. Analysis was performed using repeated measures analysis of variance. Results: When subjects used diclofenac PLO, pain was significantly less tha n that during the pretreatment, washout, and placebo PLO periods (mean VAS: diclofenac PLO, 2.1; pre treatment, 3.5; washout, 3.4: placebo PLO, 3.6). Average wrist extension strength was significantly greater when subjects us ed diclofenac PLO (8.4 kg) than it was before treatment (5.9 kg). One subje ct developed a local rash while using diclofenac PLO. Conclusion: Topical 2% diclofenac in PLO appears to provide effective short -term reduction in elbow pain and wrist extensor weakness associated with c hronic lateral epicondylitis.