Intravenous diclofenac as prophylactic treatment for verteporfin-associated low back pain.
OBJECTIVE
The authors report on the therapeutic effect of intravenous diclofenac on verteporfin associated low back pain (LBP), which is the most frequent adverse effect of photodynamic therapy (PDT) for macular degeneration.


METHODS
The authors studied 818 patients who received PDT with verteporfin for choroidal neovascularization. Systemic blood pressures were recorded in all study participants half an hour before PDT treatment. All patients who experienced LBP during verteporfin infusion were asked to grade their pain as mild (1), moderate (2), severe (3), or unbearable (4).


RESULTS
Thirty-three patients had LBP during their first verteporfin infusion. Of these, 11 subjects (1.34% of all) reported increased pain scores (level 2 to 4) and received intravenous diclofenac ahead of their next PDT. Patients with LBP during verteporfin infusion had significantly higher systolic blood pressures than uncomplicated cases (180 mmHg vs 155 mmHg, p=0.01). Treatment with intravenous diclofenac short before PDT significantly reduced the patients' mean pain score by 1.8 levels (p=0.0001).


CONCLUSIONS
In this study, intravenous application of diclofenac short before verteporfin infusion effectively prevented verteporfin associated LBP in patients with systemic hypertension.
Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen - The Netherlands. t.theelen@ohk.umcn.nl
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D000328:Adult; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000209:etiology; D004008:Diclofenac / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D017116:Low Back Pain / Q000139:chemically induced / Q000517:prevention & control*; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy; D010147:Pain Measurement; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000009:adverse effects*; D011166:Porphyrins / Q000009:adverse effects*; D011292:Premedication; D012189:Retrospective Studies; D000077362:Verteporfin
D000894:Anti-Inflammatory Agents, Non-Steroidal; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D004008:Diclofenac