Comparison of the Effectiveness of Two Different Extracorporeal Shock Wave Therapy Regimens in the Treatment of Patients With Myofascial Pain Syndrome

Abstract

Objectives: This study aims to compare the effectiveness of two different regimens of extracorporeal shock wave therapy (ESWT) in the treatment of myofascial pain syndrome. Patients and methods: Sixty four patients with active myofascial trigger points in the trapezius muscle were included in this study. Patients were randomized into two groups as patients undergoing a single session of low-energy [energy flux density (ED=0.25 mJ/mm 2 )] ESWT (group 1) and patients undergoing three sessions of ESWT with the same energy density, with one-week intervals (group 2). The effectiveness of therapy was evaluated using the number of trigger points, the Patient Global Assessment and Physician Global Assessment scales, the Neck Pain and Disability Scale, the Nottingham Health Profile and the Hamilton Anxiety Rating Scale prior to therapy and at the end of three and 12 weeks. Results: No serious complication associated with ESWT application was observed. At the end of the treatment, statistically significant improvements were achieved in the number of trigger points, pain, quality of life, and anxiety scores of patients in both groups (p<0.01). When the groups were compared regarding the effectiveness of the treatment, the improvements in the group receiving three sessions of ESWT were higher except for the anxiety scores (p<0.05). Conclusion: Low-energy ESWT is a safe and well-tolerated therapy for patients with myofascial pain syndrome and can be more efficient when administered as a three-session treatment regimen.

High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial

“…In another study, Cho et al 55 used combined therapy as radial L-ESWT for 12 sessions and stabilization shoulder exercise and found greater improvements in pain and functional scores with combined therapy. In addition, Gur et al 21 used focused H-ESWT and compared three sessions with a single session of therapy. The authors found that three sessions of therapy improved pain compared to a single-session therapy.…”

“…[6][7][8][9][10][11][12][13][14][15] Extracorporeal shock wave therapy (ESWT) is a novel, non-invasive therapeutic modality for musculoskeletal system diseases such as calcific tendinopathies, plantar fasciitis, and lateral and medial epicondylitis [16][17][18][19] as well as for MPS. [20][21][22][23][24] Although there are some theories proposed, the mechanism of action of ESWT on MPS still remains to be elucidated. The Energy Crisis Hypothesis may explain how ESWT affects other diseases.…”

Update of Extracorporeal Shockwave Therapy in Myofascial Pain Syndrome

“…Most research in shockwave therapy has focused on understanding the mechanism which results in the establishment of a mechano-sensitive feedback loop between the acoustic impulse and the stimulated cells, and involves specific transduction pathways and gene expression. Taking as valid the Energy Crisis Hypothesis, and considering the mechano-transduction effect of ESWT in other diseases [9][10][11][12][13][14][24][25][26][27][28][29] it could be posited that ESWT in MPS may increase perfusion, promote angiogenesis and alter the pain signaling in ischemic tissues caused by the influx of calcium. On the other hand, recent articles have demonstrated that free nerve endings degenerate after the application of ESWT, and that ESWT produces a transient dysfunction of nerve excitability at the neuromuscular junction, [9][10][11][12][13][14][24][25][26][27][28][29] by bringing about the degeneration of AChR.…”

“…And finally, following a pure mechanistic approach, shockwaves might be able to break-up the Actin-Myosin links, as they are propagating perpendicularly to the sarcomere contractions. [9][10][11][12][13][14][24][25][26][27][28][29] There are evidences of the efficacy of Extracorporeal Shockwave Treatment on Myofascial Pain Syndrome as in the Table 1. Müller-Ehrenberget et al 24 revealed the efficacy of focused ESWT on MPS (Piezoelectric device: Piezo Son100) for alleviating pain in 95% of the 30 patients at 3 months, (800 impulses of energy level:0.04-0.26 mJ/mm2;6 Hz; average 7 treatments, 2 sessions per week) 24 Jeon et al 25 demonstrated that 3 sessions of 1500 pulses of low energy (0.10 mJ/ mm2 ) with focused ESWT (Electrohydraulic: Evotron RFL0300) weekly is as effective as TENS and TP injection on 30 patients with MPS in trapezius muscle, measuring the results in terms of pain (visual analog scale e VAS e and McGill Pain Questionnaire), as well as on the Roles and Maudsley scale.…”

“…29 The dose of ESWT is adjusted based on the machine, the types of ESWT, the severity of conditions and the tissues to be treated.…”