Nitro Patches for Tendinopathy

[Annie Waite Gilmer]

Has anyone there had any experience with the Nitro Patches for achilles tendinopathy?
I am trying it and having a hard time with nausea and headaches. Did it work for anyone there? Not work? I'd appreciate any information! I have read the article from the Journal for Joint and Bone Surgery 2004! Thanks in advance, Annie
Geneva, Suisse

[injuryupdate]

Yes headaches are common - my latest handout for them. You can try 1/8 of a patch instead.

Nitrate patches for tendon disorders

What are nitrate patches?
Nitrate patches are a slow release of the drug glyceryl trinitrate. They have been used for many years in cardiac medicine to open up blood vessels (vasodilate) which improves blood supply to the heart. They locally vasodilate when put on other areas of the body (around tendons) and appear to help in treating chronic tendon disorders.
What is the evidence that nitrate patches work in treating tendon disorders?
There are three high quality studies published in respected journals, all which show a moderately strong positive effect of nitrate patches in treating shoulder tendinopathy, tennis elbow and Achilles tendinopathy. In all studies, the one quarter dose of a nitrate patch was compared to a placebo patch, and the patients wearing the genuine patches did better. Although the results were superior, the nitrate patches didn’t cure everyone in the studies and some people improved even without the treatment. However, the studies strongly show that the nitrate drug is helpful at resolution of chronic tendon injuries.
Are there any side effects of nitrate patches?
Yes, a substantial proportion of patients (10-25%) reported headaches and/or dizziness. In clinical practice, it appears that younger patients with low or normal blood pressure report this side effect quite commonly. The dose used in treating tendon disorders is lower than the usual dose for nitrate patches in cardiac disease, but nevertheless side effects are fairly common. The good news is that any side effects reverse very quickly after taking the patches off. Sometimes, starting on an even lower dose (1/8 of a patch) and working slowly up can help with tolerating headaches.
How low should I use them for?
In the studies published, maximum improvement was at 3-6 months, so if side effects don’t occur or are minimal, then the patches should be used for a few months (unless of course your tendon problem is cured beforehand).
Are there any drugs or medications I should avoid?
Yes, alcohol interacts somewhat so heavy drinking should be avoided if you are using a patch or vice versa. Drugs such as ******, Levitra & ****** (used to treat erection problems in males) shouldn’t be taken while wearing a nitrate patch, as these are also vasodilators.
How much do nitrate patches cost?
A box of patches will cost $35-40, but cut into quarters should last a few months. Only get NitroDur or MiniTran patches, as other brands can’t be cut into quarters. You only need ¼ of a 5mg/24 hr patch.

[Annie Waite Gilmer]

Has anyone out there used this method (nitro glycerin) ? Is there an idea for the amount of time one must wait before there is a glimmer of improvement? Is there any information concerning this treatment with insertional and non-insertional tendonitis. (I have both).
By the way, the headaches and nausea got better within one week.
Thank you for any input. Annie

[Annie Waite Gilmer]

I thought I'd give my own input! Just in case anyone else is checking into this treatment. I am now 6 weeks into this treatment and have had no improvement. I'm stopping. If anyone thinks I should go longer due to their experience, I'd appreciate hearing such!

[Nicholas]

I don't think you should go on any longer with the treatment you have tried for 6 weeks. I'd reccomend giving something else a try.

[Nicholas]

You can prevent a tendon injury (also known as tendinopathy) from developing or recurring by taking steps at home, work, and during activities to promote healing and protect your tendons.
Home treatment steps include:
Rest the affected area and avoid any activity that may cause pain. Get enough sleep. To maintain your overall health and fitness, continue exercising but only in ways that do not stress the affected area. Do not resume an aggravating activity as soon as the pain stops. Tendons require weeks of additional rest to heal. You may need to make long-term changes in the types of activities you do or how you do them.
Apply ice or cold packs as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve inflammation and speed healing in the initial stage of treatment.
Take pain relievers. Use acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin, as directed for pain relief. (Do not give aspirin to anyone younger than age 20 because of the risk of Reye's syndrome, a central nervous system complication in children.) NSAIDs also reduce any inflammation you might have in or around the tendon (tendinitis). Do not rely on medication to relieve pain in order to continue overusing a joint.
Do range-of-motion exercises each day. Gently move your joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint.
Gradually resume your activity at a lower intensity than you maintained before your symptoms began. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling.
Avoid tobacco smoke. Tendon injuries heal more slowly in smokers than in nonsmokers. Smoking impairs collagen production, which is necessary for wound and tissue healing. 3
To prevent tendon injuries from developing or from happening again:

Warm up and stretch. Warm up before any activity, and stretch gently after you finish.
Strengthen your muscles to reduce stress on the soft tissues. A physical therapist, an athletic trainer, or your health professional can teach you specific exercises for strengthening your injured area.
Evaluate and change daily activities that tend to cause or aggravate your symptoms. In your daily routine, change activities involving repeated movements that may strain your muscles or joints. For example, start alternating hands or change the grip size of your tool.
Try alternating your usual activities with some new ones. For example, if you like to walk for exercise and have had Achilles tendon problems, try swimming or doing water exercise on some days.
Notice what you do and how you do it, and take action if necessary.
If you suspect that certain activities at your workplace are causing a tendon injury, talk to your human resources department for information on alternative ways of doing your job, equipment modifications, or other job assignments.
If a certain exercise or sport is causing a tendon injury, consider taking lessons to learn proper techniques. Also, have an athletic trainer or person who is familiar with sports equipment check your equipment to ensure that it is well suited to your size, strength, and ability. Demonstrate how you use your equipment, and ask for feedback about any mistakes you might be making.
Information found at: http://health.yahoo.com/ency/healthwise/uh2113/uh2118
Hope it helps. Cheers,
Nicholas