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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∥,¶

The Clinical Journal of Pain: June 2011 - Volume 27 - Issue 5 - p 442–447
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.