The treatment of tendon pain
Tendon pain can be quite troublesome to manage with many tendons taking months and months to recover. The two key interventions with any tendon pain is to 1) Reduce the offending load on the tendon, this may include reducing exercise or the repetitive nature of tasks to let the tendon recover, and 2) strengthen the tendon with exercise therapy. These can be given to you by Physiotherapist who can help to guide you through your rehabilitation process.
Using GTN patches for tendon pain
There are other adjuncts we have for tendon pain including acupuncture, shockwave therapy and injection therapy. These all have good evidence in the management of tendon pain and each can be useful for different tendons. Another adjunct for chronic tendon pain is using GTN patches. This is something that I remember using 15 years ago working in professional football, however recently it has come back in favour and there is some interesting research evidence to support its use. GTN stands for glyceryl trinitrate and is commonly used as a drug to reduce chest pain called angina. GTN comes in a spray or a patch and when it is absorbed it increases nitric oxide production that causes vasodilation (widening of blood vessels) and improves blood flow to the heart and reduces the pain of angina. However, when we use a GTN patch over a tendon and it is absorbed into the skin it also can increase blood flow into and around the tendon which may assist with tendon healing, collagen deposition and the resolution of tendon pain.
The type of GTN patch that is recommended as a brand named Deponit 5. Other brands are substandard as the patch requires cutting to size to fit your tendon, Deponit 5 is held within a mesh network which helps to stabilise the drug and prevent it from leaking out. When you cut the patch to apply it to a tendon you would either cut it in half or in quarters and use either a half or 1/4 of a patch over the painful tendon to reduce the risk of side-effects.
Side-effects include headaches and skin rash. Headaches can be treated with paracetamol, and if use half a patch simply reduce to ¼ of a patch. The patches are usually applied first thing in the morning and then taken off at night, so you have at least 10 to 12 hours a day with the patch on. If you start to develop a slight skin rash where the patch has been applied you would simply move and reposition the following days patch to a slightly different area of skin. If you are taking any drugs for erectile dysfunction such as Viagra or Cialis you should not use GTN patches.
It is recommended that you try using the patch for at least 2 to 4 weeks, it may even require 2 to 3 months of wearing the patch to notice improvements, but this is completely in keeping with how long we know tendon problems take to resolve. If you are suffering from unresolved tendon pain and wish to discuss treatment options please get in touch.
