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Effectiveness of Leech Therapy in Chronic Lateral Epicondylitis: A Randomized Controlled Trial

Bäcker, Marcus MD*; Lüdtke, Rainer MSc; Afra, Dani MD*; Cesur, Özgur MD*; Langhorst, Jost MD*; Fink, Matthias MD; Bachmann, Jürgen MD§; Dobos, Gustav J. MD*; Michalsen, Andreas MD∥,¶

doi: 10.1097/AJP.0b013e318208c95b
Original Articles

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.

*Department of Internal and Integrative Medicine, Kliniken-Essen-Mitte

Karl and Veronica Carstens Foundation, Essen

Department of Physical Therapy, Hannover Medical School, Hannover

§Augusta Medical Clinic, Hattingen

Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre

Immanuel Hospital, Centre of Rheumatic Diseases, Berlin, Germany

Supported by a research grant from the Karl and Veronica Carstens Foundation, Germany. The funding source had a role in the design and biometrical analysis of the study.

Reprints: Andreas Michalsen, MD, Immanuel Krankenhaus Berlin, Königstrasse 63, 14109 Berlin, Germany (e-mail:

Received March 21, 2010

Accepted July 29, 2010

© 2011 Lippincott Williams & Wilkins, Inc.