Effect of extracorporeal shock wave therapy on scar pain in burn patients

Abstract

Background:Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients.Methods:A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm2 (0.05–0.15 mJ/mm2) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores.Results:The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm2), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128).Conclusion:ESWT significantly reduced scar pain in burn patients after wound recovery.

Factors Influencing Resilience of Burn Patients in South Korea

“…In this manner, burn patients may experience various psychosocial and emotional difficulties. However, previous studies regarding burn patients have mainly focused on physical treatment, including wound care (Lee et al., ; Stoddard et al., ), nutrition therapy (Cho, ; Roh, Chung, Kwon, & Kim, ), and scar pain treatment (Cho & Seo, ; Ullrich, Askay, & Patterson, ), among others. Protein, vitamin C, zinc, and copper for healing of burn wounds have been described as appropriate nutrition therapy (Cho, ; Roh et al, ), and medication use and dressing treatment have been described for alleviation of pain (Cho & Seo, ; Ullrich et al, ).…”

A Matter of Gravity-Mechanotransduction: How Mechanical Forces Influence Biological Materials

“…Activation of these moieties leads to changes in protein synthesis, altered gene expression and cell mitosis [8]. All these events occur at the cell-tissue interface and dictate rate, composition and extent of tissue that is deposited [15,16]. Providing the correct boundary forces and stresses to equilibrate the celltissue interface is important to prevent cellular hyperplasia and excessive collagen deposition.…”

“…In addition, pulsed electromagnetic fields for promotion of tendon healing and extracorporeal shock wave therapy for bone regeneration and chronic wound healing have gained acceptance [18]. Extracorporeal shock wave therapy has been used to reduce scar pain in burn patients after wound recovery [16]. Vacuum massage and negative pressure induced wound healing have also been studied for their effects on healing.…”

“…Tension appears to have positive effects on wound healing in a number of studies. Recent reviews suggest that negative pressure wound healing (that occur by applying a vacuum to wounds), physical therapy protocols, and extracorporeal shock [16] wave therapy are treatments that promote healing through mechanotransduction [17,18]. The link between movement biomechanics, physical therapy, and subsequent cellular and tissue mechanoadaptation is not well established; however, altered joint physiology has been shown to occur as a result of physical therapeutic intervention in osteoarthritis, anterior cruciate ligament reconstruction and total knee arthroplasty [18].…”

“…If implantation of a medical device such as a breast implant creates pressure, or if there is too much pressure as a result of suturing skin after breast reduction surgery [15] interruption of the normal lines of tension within the breast lead to changes in mechanotransduction that result in the deposition of a collagenous capsule or scar tissue [1]. Pressure generating wound dressings are known to cause changes in collagen metabolism in hypertrophic scar tissue [16] suggesting that pressure either from a dressing or from an implant pressing on host tissue can cause tissue catabolism.…”