Effects of repeated injection of 1% lidocaine vs. radial extra-corporeal shock wave therapy for treating myofascial trigger points: a randomized controlled trial

Abstract

Purpose: To compare the efficacy of radial extracorporeal shockwave therapy (rESWT) versus injection of 1% lidocaine for active myofascial trigger points (MTPs) at upper trapezius muscle (UTM) objectively with elastic index analysis. Patients and methods: A prospective, randomised, single-blinded clinical trial was done. 60 patients with active MTPs of UTM were randomised to receive either rESWT (n = 30); three rESWT sessions; one session per week; 2000 rESWT impulses per session; positive energy flux density = 0.10 mJ/mm2) or 1% lidocaine (4 ml) injection (n = 30) (three injections; one injection per week). The outcome measure was the elastic index of MTPs, visual analogue score (VAS score) of pain, and pressure pain threshold (PPT) three weeks after baseline. Results: Both rESWT and injection of 1% lidocaine resulted in statistically significant (P < 0.05) reduced elastic index and VAS of pain of UTM and PPT significantly (P < 0.05) at three weeks after baseline. The mean differences between rESWT and injection of 1%lidocaine showed no statistically siginificance. Conclusion: Both rESWT and 1% lidocaine injection had efficacy for active MTPs of UTM measured with elastic index, VAS of pain and PPT.

Effects of Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves

“…The second take-home message of this study is that different tissues respond to the same mechanical stimulus in different ways. Based on many years of clinical experience and numerous clinical studies, various pathologies of the musculoskeletal system are nowadays known that can be successfully treatet with ESWT [8][9][10][11]200,227,229]. These indications include mainly degenerations and injuries of muscle, bone and cartilage tissue.…”

“…Furthermore, it cannot be excluded that ESWT is influencing the conduction ability of sensitive nerves through activation of gate control mechanisms in the spinal cord [228]. Compared to neural therapy, a recent study demonstrated that in patients with myofascial trigger points in the upper trapezius, both repeated injection of 1% lidocaine and rESWT resulted in reduced pain alongside improved muscle elasticity, pressure pain threshold and neck disability index [229].…”