Efficacy of extracorporeal shock waves in the treatment of myofascial pain syndrome: a systematic review and meta-analysis of controlled clinical studies

Abstract

Background: Myofascial pain syndrome (MPS) is recurrent local myofascial pain with various treatment methods. In recent years, extracorporeal shock wave therapy (ESWT) has attracted much attention, but its role still lacks systematic review. We included controlled clinical studies for meta-analysis to systematically evaluate the application effect of ESWT. Methods:The English literature from PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science to October 2021 was searched by computer. After screening, the quality was evaluated by the PEDro (Physiotherapy Evidence Database) scale and analyzed by RevMan 5.4 software.Results: A total of 571 patients were included in 8 studies. The MPS pain sites of 541 patients were in the neck and upper back, and only 30 patients had pain sites in the waist. Meta-analysis showed that the pain level after ESWT was lower than that after other treatment methods [mean difference (MD) =−1.34, 95% confidential interval (CI): −1.87 to −0.81, P<0.00001], the pain threshold after ESWT was higher than that after other treatment methods (MD =0.90, 95% CI: 0.73 to 1.07, P<0.00001), and the neck disability index after ESWT was lower (MD =−1.79, 95% CI: −2.48 to −1.10, P<0.00001).Discussion: ESWT can avoid the adverse effects of invasive procedures on patient tolerance and compliance; compared with trigger point injection (TPI), dry needling, ultrasound-guided pulsed radiofrequency (US), and other methods, ESWT can more effectively relieve pain in patients with MPS.

Immediate effect of shock wave versus muscle energy technique in cases of quadratus lumborum myofascial pain

“…Also, combined with stabilization training, shock wave was found effective in the longterm achieving stable effects for patients with LBP [19]. In addition, ESWT can avoid the adverse effects of invasive procedures on patient tolerance and compliance [20]. However, when comparing our findings with previous studies considering trigger points in other locations than the QL, previous studies showed no significant effects on reducing pain and improving function.…”

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

“…Treatment of MTrPs with ESWT was also applied in a number of other studies that were not considered in the systematic review and meta-analysis performed in [38] [20,22-25,27,28,31,33,37]. However, except for one study [24] ESWT was not compared to injections of lidocaine (or other local anesthetics) in these studies.…”

“…During the last decades, extracorporeal shock wave therapy (ESWT) has emerged as an effective and safe alternative for treating MTrPs [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. According to a recent systematic review and meta-analysis, ESWT appears to be associated with higher pain alleviation than sham ESWT or ultrasound therapy in treatment of MTrPs in the UTM [38]. Most importantly, there was no statistically significant difference in pain intensity or neck disability index when compared the outcome of ESWT to the outcome of conventional therapies (dry needling, trigger point injection, laser therapy) [38].…”

“…According to a recent systematic review and meta-analysis, ESWT appears to be associated with higher pain alleviation than sham ESWT or ultrasound therapy in treatment of MTrPs in the UTM [38]. Most importantly, there was no statistically significant difference in pain intensity or neck disability index when compared the outcome of ESWT to the outcome of conventional therapies (dry needling, trigger point injection, laser therapy) [38]. This study tested the hypothesis that treatment of MTrPs in the UTM with repeated injection of 1% lidocaine results in better alleviation of muscular stiffness and soreness as well as improved metabolism in the hypercontracted MTrP area than treatment with radial ESWT (rESWT).…”

Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke

“…Extracorporeal shock waves, acting on human tissues, may produce different physical stress effects in the area of action through the human medium, namely tensile stress and shear force, thereby causing tissue release, improving the microcirculation of muscles and thus relieving the state of muscle spasm in patients ( 68 – 70 ). A meta-analysis showed that ESWT improves passive joint mobility and muscle properties such as stiffness, tension, and elasticity, which are thought to be related to the rheological properties of shock waves on spastic muscles ( 71 ).…”