NTG without rehab works no better than placebo
Another RCT that evaluated 3 different doses of NTG patches for 8 weeks in 154 patients with chronic lateral epicondylosis found NTG treatment was no better than placebo for pain or strength.5 Investigators randomized patients with more than 3 months of symptoms to 3 NTG patch doses (.72 mg/24 h, 1.44 mg/ 24 h, or 3.6 mg/24 h) compared with placebo and evaluated subjective pain (at rest, with activity, and at night), grip strength, and force, at baseline and 8 weeks.
The study lacked a formal wrist strengthening rehabilitation program. Patients in the placebo group had lower baseline pain scores than the NTG groups. Seven patients dropped out of the study because of headaches.
RECOMMENDATIONS
We found no authoritative recommendations regarding the use of topical nitrates for upper extremity tendinopathies.
An online reference text doesn’t make a recommendation, but references the studies described previously.6 The authors state that headache is the most common adverse effect of topical nitrates, but it becomes less severe over the course of treatment. They recommend caution in patients with hypotension, pregnancy, or migraines, and those who take diuretics. The authors also note that nitrates are relatively contraindicated in patients with ischemic heart disease, anemia, phosphodiesterase inhibitor therapy (such as sildenafil), angle-closure glaucoma, and allergy to nitrates.