Background: Musculoskeletal pain is a quite common, benign, nonfatal condition that is the second leading cause of years lived with a disability worldwide. Despite all efforts, it continues to be a challenging public health problem, because the solutions currently available are complex or are of limited effectiveness, which makes them difficult to adopt. That situation perpetuates suffering and treatment seeking, as well as increasing the health care costs and burden associated with such pain. Therefore, new treatment options need to be tested and the interest in shock waves is growing, especially in places with few resources, with difficult access to medications and in countries where there is a need for new therapeutic options due to the opioid crisis.Methods: This was a retrospective observational study of 1,580 patients with musculoskeletal pain who underwent two weekly sessions of radial extracorporeal shock-wave therapy.Results: We found that the therapy tested decreased pain by 62.50% (P < 0.0001), with a high (91.59%) success rate and a low (2.1%) rate of pain worsening (2.1%). The effect was greatest for myofascial pain in the hip or shoulder (P < 0.05). Intense pain, myofascial pain (visual analogue scale score ≥ 70 mm), and high shock-wave frequency (≥ 15 Hz) correlated with best response. Conclusions: It is possible to implement a radial shockwave service that, with just two doses, promotes rapid and effective analgesia for up to 7 days after the last dose, with a high success rate and a low rate of abandonment of treatment. Representing a response to the management of service overload and a non-drug alternative in the era of the opioid crisis.Study registration: CAAE 51289115.2.0000.5463. Registered 7th October 2015 (prospectively registered).

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