Diclofenac for pain associated with intravitreal injections: a prospective, randomized, placebo‐controlled study

• Published in: Clinical & experimental ophthalmology 2017-12, Vol.45 (9), p.867-874
• Main Authors: Makri, Olga E, Tsapardoni, Foteini N, Pagoulatos, Dionisios D, Pharmakakis, Nikolaos, Georgakopoulos, Constantine D
• Format: Article
• Language: English
• Subjects: Administration, Oral; Administration, Topical; Aged; Analgesics; Angiogenesis Inhibitors - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; anti‐VEGF; Diclofenac; Diclofenac - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Humans; intravitreal injection; Intravitreal Injections - adverse effects; Male; Middle Aged; Nonsteroidal anti-inflammatory drugs; Ophthalmic Solutions; Ophthalmology; Pain; Pain - diagnosis; Pain - drug therapy; Pain - etiology; Pain Measurement; Prospective Studies; Randomization; Ranibizumab - administration & dosage; Receptors, Vascular Endothelial Growth Factor - administration & dosage; Receptors, Vascular Endothelial Growth Factor - antagonists & inhibitors; Recombinant Fusion Proteins - administration & dosage; Retinal Diseases - drug therapy; short form of the McGill Pain Questionnaire; Statistical analysis; Time Factors; Treatment Outcome
• ISSN: 1442-6404; 1442-9071
• DOI: 10.1111/ceo.12988

Importance Intravitreal injections (IVI) are often painful. Background To evaluate the analgesic effect of diclofenac in patients undergoing IVI. Design Single‐centre, prospective, randomized, triple‐arm, placebo‐controlled, interventional study in the University Hospital of Patras. Participants Seventy‐four patients. Methods Group 1 (n = 25) received topical diclofenac 45 min before IVI, Group 2 (n = 25) received oral diclofenac 4 h before IVI and topical diclofenac while Group 3 (n = 24) received placebo before IVI. Using the short form of the McGill Pain Questionnaire (SF‐MPQ), pain intensity was assessed with the visual analogue scale (VAS), the main component of the SF‐MPQ and the Present Pain Intensity (PPI) scores immediately and 6 h post‐IVI. Main Outcome Measures The VAS pain score immediately post‐IVI. Results Immediately post‐IVI, patients in Group 2 reported significantly lower VAS pain scores compared to placebo while no statistically significant difference was found between patients that received topical diclofenac and placebo. Six hours post‐IVI, patients in both treatment groups reported significant lower VAS pain scores compared to placebo. The scores of the main component of the SF‐MPQ were significantly lower in patients of treatment groups compared to placebo at both time‐points. Finally, while no statistically significant difference was found between the 3 Groups in PPI scores immediately post‐IVI, 6 h later, patients of both treatment groups reported significantly lower PPI scores compared to placebo. Conclusions and Relevance The combination of topical and oral diclofenac demonstrated better analgesic effect than topical diclofenac administration in patients undergoing IVI immediately and up to 6 h post‐IVI.