Effects of Topical Diclofenac Plus Heparin (Dhep+H Plaster) on Somatic Pain Sensitivity in Healthy Subjects With a Latent Algogenic Condition of the Lower Limb. Issue 1 (17th January 2014)

• Record Type: Journal Article
• Authors: Affaitati, Giannapia; Fabrizio, Alessandra; Frangione, Valeria; Lanzarotti, Arturo; Lopopolo, Mariangela; Tafuri, Emmanuele; Lapenna, Domenico; Giamberardino, Maria Adele; Costantini, Raffaele
• Is Part Of: Pain practice. Volume 15:Issue 1(2015)
• Page Start: 58
• Page End: 67
• Publication Date: 2014-01-17
• Subjects: Pain -- Treatment -- Periodicals; 616.0472
• DOI: 10.1111/papr.12161
• Languages: English
• ISSNs: 1530-7085

Abstract

<abstract abstract-type="main" id="papr12161-abs-0001"> <title>Abstract</title> <sec id="papr12161-sec-0001" sec-type="section"> <title>Objective</title> <p>To evaluate whether a diclofenac epolamine + heparin topical (plaster) is more effective than diclofenac plaster alone in reducing deep somatic hyperalgesia in subjects without spontaneous pain and whether the effect is linked to or independent of the anti‐edematous action of heparin.</p> </sec> <sec id="papr12161-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective, double‐blind, randomized and controlled, four‐arm parallel design trial.</p> </sec> <sec id="papr12161-sec-0003" sec-type="section"> <title>Subjects</title> <p>One hundred and four patients (84 women, 20 men, mean age 42.2 ± 13.3 years), with deep somatic hyperalgesia in one thigh, randomly assigned to one of 4 groups of 26 each.</p> </sec> <sec id="papr12161-sec-0004" sec-type="section"> <title>Intervention</title> <p>Each group underwent one of the following plaster treatments on one thigh: diclofenac+heparin; diclofenac; heparin; placebo, for 7 days, renewing the plaster every 24 hours.</p> </sec> <sec id="papr12161-sec-0005" sec-type="section"> <title>Outcome Measures</title> <p>Before treatment (day 1), at day 4 and day 8, assessment of (a) pressure and electrical pain thresholds of vastus lateralis and overlying subcutis and skin; and (b) structure/thickness of subcutis and muscle with ultrasounds at the same level.</p> </sec> <sec id="papr12161-sec-0006" sec-type="section"> <title>Results</title> <p>During treatment, in placebo and heparin, no significant threshold changes, except subcutis thresholds which increased slightly (<italic>P</italic> < 0.02); in diclofenac and diclofenac+heparin, significant increase in all thresholds (0.0001 < <italic>P</italic> < 0.04). Electrical muscle pain thresholds increased significantly more in diclofenac+heparin than in diclofenac, heparin, and placebo (0.0001 < <italic>P</italic> < 0.04). In all groups: no edema and thickness changes at ultrasounds in muscle and subcutis.</p> </sec> <sec id="papr12161-sec-0007" sec-type="section"> <title>Conclusions</title> <p>Topical diclofenac+heparin is significantly more effective than diclofenac alone in reducing muscle hyperalgesia in subjects without spontaneous pain, independently of the anti‐edematous action of heparin. The results provide a rationale for the use of diclofenac+heparin also in algogenic conditions without evident signs of injury/edema/hematoma.</p> </sec> </abstract>