GTN (glyceryl trinitrate) patches have become a non invasive alternative treatment for persistent tendon pain. Other adjuncts such as Shockwave Therapy have been shown to be effective, but sometimes tendons can be stubborn. Injection therapy can also be useful but is more invasive and can pose risks to the tendon.

GTN patches are non invasive and were traditionally used for the treatment of angina which occurs in heart disease. The GTN is absorbed through the skin into the small blood vessels which then dilate and allows increased blood flow.

When using a GTN patch in the treatment of a painful tendon, we place the patch directly over the painful site to have an affect on tendon healing. 

How does GTN improve tendon pain?

The mechanisims are not fully understood however researchers think GTN increases levels of a molecule called nitric oxide. We know that nitric oxide opens the blood vessels but we think it also stimulates collagen and tendon healing.

Recent studies show that using a GTN patch over a painful tendon alongside an exercise routine helped improve patients pain.  

It’s important to remember NOTHING replaces the need to do your Physiotherapy exercises as well!

How do you use GTN patches in the treatment of your tendon pain?

The most important thing is getting the right diagnosis first. GTN patches will only work with tendinopathy. If your tendon is swollen and “creaking” its likely to be a different diagnosis. If you felt a ‘snap’ or ‘pop’ just prior to your pain starting, again we need to make sure your diagnosis is tendinopathy and not a tear of some sort. 
If we haven’t performed an ultrasound scan of your tendon, we suggest you get one in the first instance to confirm the diagnosis. 
The next most important thing to note is that it will work best when the tendon is just under the skin i.e superficial. That means it’s most appropriate for the achilles tendon, tennis elbow, patellar tendon and lateral ankle tendons. 
GTN patch application advice.
Once we have identified where to place the patch you should start with half a patch. This is to reduce the chances of side effects you might get. Cut the patch in half and place half a patch onto the skin over the most tender part of the tendon. Dont use the other half of the patch. Throw it away!
Put the patch on in the morning and take it off at night to rest the area and prevent overloading the area with GTN. You should always take the patch off overnight. 

You can exercise and shower with the patch on through the day but stop if you notice any skin irritation that is not settling overnight. If you are tolerating half a patch after a few days you can progress up to 1 patch per day. 

We suggest using a patch for 2-3 months to help with pain alongside your exercise plan. Some studies looked at using the patch for much longer in severe cases for up to 6 months. 

Are there side effects when using a GTN patch?

The most common side effect is a headache. This is due to the effects on the blood vessels mentioned earlier. Paracetamol may help alleviate this and your body is likely to acclimatise to the patch so the headaches should reduce. You could also reduce the dose by only using 1/4 of a patch and progress up from there. 

Skin rash can be common too. Move the patch slightly each administration to give the irritated area some respite. Don’t stray too far from the tender part of the tendon or it may not have the desired effect. 

There could be interactions with other medications that you currently take,  so please check with your GP before using.

Key facts from the studies:

  • Using the topical patch for up to 6 months is superior to placebo
  • Useful adjunct for non-responders to other treatments in chronic tendon pain
  • Side effects include headaches  due to cerebral vasodilation (Increased blood flow to the head)

Please contact us for further advice regarding your tendon pain if you have any questions.