EFFICACY OF DICLOFENAC GEL IONTOPHORESIS IN THE TREATMENT OF CHRONIC CERVICAL PAIN: A RANDOMIZED CONTROLLED STUDY

Abstract

Chronic cervical pain is a common musculoskeletal condition that affects a significant proportion of the adult population worldwide. It is frequently linked to modern sedentary lifestyles, poor ergonomics, and degenerative changes of the cervical spine, especially among working-age individuals. When left untreated or inadequately managed, chronic neck pain can result in reduced range of motion, muscle stiffness, decreased productivity, and diminished quality of life. The persistent and recurring nature of symptoms often leads to frustration for both patients and clinicians. Conservative treatment methods, including nonsteroidal anti-inflammatory drugs (NSAIDs), manual therapy, and kinesitherapy, are often only partially effective or provide short-term relief. As a result, there is growing interest in non-invasive therapeutic approaches that enhance drug delivery and improve outcomes.
The aim of this randomized controlled study was to evaluate the therapeutic effectiveness and tolerability of iontophoresis with 1% diclofenac gel compared to conventional topical application of the same drug in patients suffering from chronic nonspecific neck pain. Sixty patients aged between 25 and 65 years were enrolled and randomly assigned into two groups of equal size. The experimental group received diclofenac via iontophoresis using a direct current of 0.5 mA/cm² for 20 minutes, three times per week, over a four-week period. The control group applied the same gel to the cervical area without electrical stimulation. Both groups underwent identical kinesitherapy exercises designed to improve cervical flexibility and muscle strength. Outcome measures included the Visual Analogue Scale (VAS) for pain intensity, the Neck Disability Index (NDI) for functional limitation, and cervical range of motion (CROM) assessments in multiple directions. Evaluations were conducted at baseline, after 2 and 4 weeks of therapy, and during a follow-up session two weeks post-treatment. The results demonstrated significantly better outcomes in the iontophoresis group, including more substantial pain reduction (mean decrease of 3.2 units on VAS), greater functional improvement (NDI reduction of 8.5 points), and enhanced cervical mobility (average increase of 18 degrees), compared to the control group. Mild adverse events such as temporary skin redness were observed in a small number of participants but did not require discontinuation of therapy. No systemic or serious adverse effects were reported.
In conclusion, iontophoresis appears to be a safe and effective adjunct to conventional therapy for chronic cervical pain, enhancing the pharmacological action of topical NSAIDs. It is easy to apply, time-efficient, and well-tolerated. Its inclusion in rehabilitation protocols could reduce the need for systemic medications and improve patient adherence. Further longitudinal studies with larger populations are recommended to evaluate the sustainability of its benefits, determine optimal dosing parameters, and assess its cost-effectiveness in routine practice.