Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial.

Objectives: Leech therapy has been found to be effective in osteoarthritis of the knee and hand in previous trials. Chronic epicondylitis is a prevalent pain syndrome with limited treatment options. In this study, we tested whether leech therapy would be beneficial in the symptomatic treatment of chronic lateral epicondylitis. Methods: Forty patients with manifestation of epicondylitis of at least 1-month duration were randomized to a single treatment with 2 to 4 locally applied leeches or a 30-day course with topical diclofenac. The primary outcome was change of pain sum score on day 7 calculated from 3 visual analog scales for pain during motion, grip, and rest. Secondary outcomes included disability (Disability of the Arm, Shoulder, Hand questionnaire), physical quality of life (Short Form-36), and grip strength. Outcomes and safety were assessed on days ―3, 0, 7, and 45. Results: Leeches induced a significantly stronger decrease of the pain score (143.7 36.9 to 95.3 ± 45.1) compared with topical diclofenac (131.6 ± 29.6 to 134.7 ± 70.7; mean difference ―49.0; 95% confidence interval, ―82.9―15.1; P = 0.0075) after 7 days. On day 45, this group difference was reduced (―27.5; confidence interval, ―60.8-5.8; P=0.110) due to delayed pain relief with diclofenac. Functional disability showed a stronger decrease in the leech group, which was most prominent after 45 days (P=0.0007). Quality of life increased nonsignificantly in the leech group. Results were not affected by outcome expectation. Discussion: A single course of leech therapy was effective in relieving pain in the short-term and improved disability in intermediate-term. Leeches might be considered as an additional option in the therapeutic approach to lateral epicondylitis.