Abstract
Objectives: To investigate the clinical efficacy and safety of a newly developed diclofenac patch in the topical treatment of blunt impact injuries.
Methods: This was a randomised, placebo controlled, double blind, multicentre study in 120 patients with traumatic blunt soft tissue injury. Within 3 h of the injury participants of sport competitions and training camps were enrolled and treated twice daily with the diclofenac or a placebo patch over a period of 7 days. Patients were randomised (1:1) to two parallel groups. Tenderness produced by pressure was measured twice daily during the first 3 days after enrolment as well as at day 7. Tenderness was defined as the amount of pressure (measured by a calibrated caliper at the centre of the injury) that first produced a pain reaction as reported by the patient.
Results: The primary efficacy variable was the area under the curve for tenderness over the first 3 days. The diclofenac patch was significantly more effective than placebo (p<0.0001). The treatment effect was 64.7 kp h/cm2 (95% confidence interval 48.7 to 80.9) between diclofenac and placebo patches. These results were supported by all secondary efficacy variables. The diclofenac patch produced rapid pain relief as reflected by the time to reach resolution of pain at the injured site which was significantly shorter compared to placebo (p<0.0001). The diclofenac patch was well tolerated. The most frequently observed adverse events were local cutaneous adverse reactions (pruritus, rash) of minor severity occurring with the same frequency as in the placebo group.
Conclusions: A newly developed diclofenac patch is effective and safe for the treatment of blunt impact injuries.
Full Text
The Full Text of this article is available as a PDF (126.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Affaitati G., Vecchiet F., Lerza R., De Laurentis S., Iezzi S., Festa F., Giamberardino M. A. Effects of topical diclofenac (DHEP plaster) on skin, subcutis and muscle pain thresholds in subjects without spontaneous pain. Drugs Exp Clin Res. 2001;27(2):69–76. [PubMed] [Google Scholar]
- Almekinders L. C. Anti-inflammatory treatment of muscular injuries in sport. An update of recent studies. Sports Med. 1999 Dec;28(6):383–388. doi: 10.2165/00007256-199928060-00001. [DOI] [PubMed] [Google Scholar]
- Assandri A., Canali S., Giachetti C. Local tolerability and pharmacokinetic profile of a new transdermal delivery system, diclofenac hydroxyethylpyrrolidine plaster. Drugs Exp Clin Res. 1993;19(3):89–95. [PubMed] [Google Scholar]
- Bateman D. N., Kennedy J. G. Non-steroidal anti-inflammatory drugs and elderly patients. BMJ. 1995 Apr 1;310(6983):817–818. doi: 10.1136/bmj.310.6983.817. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davies N. M., Anderson K. E. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet. 1997 Sep;33(3):184–213. doi: 10.2165/00003088-199733030-00003. [DOI] [PubMed] [Google Scholar]
- Gallacchi G., Marcolongo R. Pharmacokinetics of diclofenac hydroxyethylpyrrolidine (DHEP) plasters in patients with monolateral knee joint effusion. Drugs Exp Clin Res. 1993;19(3):95–97. [PubMed] [Google Scholar]
- Gøtzsche P. C. Non-steroidal anti-inflammatory drugs. BMJ. 2000 Apr 15;320(7241):1058–1061. doi: 10.1136/bmj.320.7241.1058. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heyneman C. A., Lawless-Liday C., Wall G. C. Oral versus topical NSAIDs in rheumatic diseases: a comparison. Drugs. 2000 Sep;60(3):555–574. doi: 10.2165/00003495-200060030-00004. [DOI] [PubMed] [Google Scholar]
- Heyneman C. A. Topical nonsteroidal antiinflammatory drugs for acute soft tissue injuries. Ann Pharmacother. 1995 Jul-Aug;29(7-8):780–782. doi: 10.1177/106002809502907-822. [DOI] [PubMed] [Google Scholar]
- Huskisson E. C. Measurement of pain. Lancet. 1974 Nov 9;2(7889):1127–1131. doi: 10.1016/s0140-6736(74)90884-8. [DOI] [PubMed] [Google Scholar]
- Matthews J. N., Altman D. G., Campbell M. J., Royston P. Analysis of serial measurements in medical research. BMJ. 1990 Jan 27;300(6719):230–235. doi: 10.1136/bmj.300.6719.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moore R. A., Tramèr M. R., Carroll D., Wiffen P. J., McQuay H. J. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs. BMJ. 1998 Jan 31;316(7128):333–338. doi: 10.1136/bmj.316.7128.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Müller M., Rastelli C., Ferri P., Jansen B., Breiteneder H., Eichler H. G. Transdermal penetration of diclofenac after multiple epicutaneous administration. J Rheumatol. 1998 Sep;25(9):1833–1836. [PubMed] [Google Scholar]
- Ogilvie-Harris D. J., Gilbart M. Treatment modalities for soft tissue injuries of the ankle: a critical review. Clin J Sport Med. 1995 Jul;5(3):175–186. doi: 10.1097/00042752-199507000-00008. [DOI] [PubMed] [Google Scholar]
- Pabst H., Segesser B., Bulitta M., Wetzel D., Bertram S. Efficacy and tolerability of escin/diethylamine salicylate combination gels in patients with blunt injuries of the extremities. Int J Sports Med. 2001 Aug;22(6):430–436. doi: 10.1055/s-2001-16251. [DOI] [PubMed] [Google Scholar]
- Radermacher J., Jentsch D., Scholl M. A., Lustinetz T., Frölich J. C. Diclofenac concentrations in synovial fluid and plasma after cutaneous application in inflammatory and degenerative joint disease. Br J Clin Pharmacol. 1991 May;31(5):537–541. doi: 10.1111/j.1365-2125.1991.tb05576.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Szczesny Grzegorz, Olszewski Waldemar L. The pathomechanism of posttraumatic edema of lower limbs: I. The effect of extravasated blood, bone marrow cells, and bacterial colonization on tissues, lymphatics, and lymph nodes. J Trauma. 2002 Feb;52(2):315–322. doi: 10.1097/00005373-200202000-00018. [DOI] [PubMed] [Google Scholar]
- Vaile J. H., Davis P. Topical NSAIDs for musculoskeletal conditions. A review of the literature. Drugs. 1998 Nov;56(5):783–799. doi: 10.2165/00003495-199856050-00004. [DOI] [PubMed] [Google Scholar]
- Waikakul S., Danputipong P., Soparat K. Topical analgesics, indomethacin plaster and diclofenac emulgel for low back pain: a parallel study. J Med Assoc Thai. 1996 Aug;79(8):486–490. [PubMed] [Google Scholar]
- Wetzel D., Menke W., Dieter R., Smasal V., Giannetti B., Bulitta M. Escin/diethylammonium salicylate/heparin combination gels for the topical treatment of acute impact injuries: a randomised, double blind, placebo controlled, multicentre study. Br J Sports Med. 2002 Jun;36(3):183–188. doi: 10.1136/bjsm.36.3.183. [DOI] [PMC free article] [PubMed] [Google Scholar]