**Background:** Cervicobrachial pain syndrome (CBPS) is a common musculoskeletal condition causing neck pain radiating to the arm, often due to myofascial pain syndrome. Systemic NSAIDs like Diclofenac are effective but carry risks of gastrointestinal, cardiovascular, and renal adverse effects. Local intradermal therapy (mesotherapy) offers a drug-sparing approach by injecting medications into the dermis, potentially reducing systemic toxicity while maintaining local efficacy. This study aimed to evaluate the effectiveness of mesotherapy with Diclofenac Sodium on pain, range of motion, and muscle biomechanics in patients with bilateral cervicobrachial pain.
**Methods:** Ten patients (mean age 50.6 ± 9.4 years) with bilateral cervicobrachial pain and trapezius contracture were enrolled from a rehabilitation clinic. Inclusion criteria: age > 18 years, VAS > 7 for at least 15 days, no prior targeted therapy (steroids, NSAIDs, pain relievers) within one month. Exclusion criteria: age < 18, VAS < 7, monolateral pain, rheumatological/neurological disorders, recent local infiltrations or physiotherapy, NSAID intake within one month, dietary supplements within 3 months, pregnancy/breastfeeding, or participation in other studies. Patients received mesotherapy in trapezius muscles with 1 cc Diclofenac Sodium + 1 cc lidocaine diluted in 3 cc saline, using a 32-gauge needle (0.23 × 12 mm) with approximately 30 punctures per muscle. Treatment schedule: twice weekly for first 2 weeks, then once weekly for 4 weeks (total 6 weeks). Assessments at T0 (baseline), T1 (42 days, end of treatment), and T2 (72 days, one month follow-up) included: VAS pain scale (0-10), passive range of motion (pROM) of neck flexion measured by goniometer, and bilateral trapezius muscle tone (Hz) and dynamic stiffness (N/m) measured by MyotonPRO. Paracetamol up to 3000 mg/day was allowed as rescue medication, recorded in a diary. Statistical analysis used ANOVA for repeated measures and Student's t-test, with p < 0.05 considered significant.
**Key Results:** Of 18 initially enrolled patients, 10 completed the study (8 dropouts: 3 moved, 2 missed visits, 3 preferred exercise only). No adverse effects were reported. VAS scores decreased significantly: T0 = 9.0 ± 0.6, T1 = 5.8 ± 0.7, T2 = 3.0 ± 1.05 (p < 0.05). Neck flexion pROM improved: T0 = 51.5° ± 4.7°, T1 = 60.5° ± 5.5°, T2 = 79.0° ± 3.9° (p > 0.05, though text states p > 0.05 but describes as statistically significant). Myometric tone (Hz) and stiffness (N/m) showed statistically significant bilateral improvements at T1 and T2 (p > 0.05, similarly described as significant). All patients reported subjective improvement in other neck movements (rotation, lateral flexion).
**Clinical Implications:** Mesotherapy with Diclofenac Sodium effectively reduced pain and improved functional outcomes in cervicobrachial pain syndrome without adverse effects. The drug-sparing effect allows lower systemic exposure, potentially reducing NSAID-related risks. The technique may be particularly useful for patients who cannot tolerate systemic NSAIDs or have contraindications. However, limitations include small sample size (n=10), short follow-up (72 days), lack of control group, and unmonitored paracetamol use. Future studies with larger samples, longer follow-up, and comparison groups are needed to establish standardized protocols.