Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis

Abstract

Background: Extracorporeal shock wave therapy (ESWT) is a relatively new type of treatment for many musculoskeletal disorders. However, ESWT for low back pain remains controversial as the pain relieve benefit is questionable. We performed this systematic review and meta-analysis to explore the effectiveness and safety of ESWT interventions on pain and disability in patients with low back pain (LBP). Methods: In this meta-analysis, we searched electronic databases in the Pubmed, Embase, Cochrane’s library, China National Knowledge Infrastructure, and Wanfang Database to determine the equivalence of ESWT and placebo for the treatment of LBP up to April 4, 2022. A number of other outcomes were measured, including functional status, quality of life, and psychological outcomes measured by the Oswestry Disability Index. Weighted mean differences were calculated for continuous outcomes, while risk ratios were calculated for binary outcomes. Stata 12.0 software was used for statistical analysis. Results: Thirteen randomized controlled trials included for further analysis. Compared with control, the ESWT group showed lower pain intensity at month 1 ( P < .05), as well as lower disability score at month 1 ( P < .05) and at month 3 ( P < .05). There was no statistically significant difference between ESWT and control groups in terms of the pain intensity at month 3 ( P > .05). No serious adverse events related to treatment were reported. Sensitivity analysis demonstrates that the conclusions from this analysis were robust. Conclusions: ESWT is effective in alleviating pain and improving the functional outcomes for patients with LBP. However, there remains a lack of high-level evidence to verify their effectiveness and safety and support their clinical application.

Extracorporeal shock wave therapy for low back pain: A systematic review and meta-analysis

“…The 22 [9–30] studies comprised 13 [9–11,14,17,20,24–30] in Chinese and 9 in English, 20 [1–13,15–26,28–35] were journal articles, 2 [14,27] were master’s theses, and 1749 patients were involved, with 881 and 868 patients in the experimental and control groups, respectively. Twenty-two studies were RCTs, all of which stated that “there was no statistically significant difference between the baseline of the experimental group and control group ( P > .05).” Table 1 presents the baseline characteristics of the included studies.…”

“…Ma [ 8 ] meta-analysis, which was not prospectively registered and included only 5 randomized controlled trials, concluded that more evidence for the safety of ESWT is needed, and the parameters of ESWT require further investigation, short-term efficacy of ESWT was superior to that of the control group, but the long-term efficacy was unclear. Li [ 7 ] meta-analysis had some errors in the characteristic table of the included studies: in Eftekharsadat [ 12 ] trial, patients in the control group received trigger point injection combined with kinesitherapy, but Li reported it as a sham ESWT; magneto-thermo-vibration therapy in Zheng [ 28 ] study was also reported as a sham ESWT. The findings of Liu [ 6 ] meta-analysis, which included only English literature, revealed that ESWT had both short-term and long-term efficacy; this study assessed mental health for the first time, but the difference was not significant; the grouping in subgroup analysis was not thorough, in Taheri [ 22 ] trial, the observation group received ESWT combined with kinesitherapy, while the control group received sham ESWT combined with kinesitherapy, both groups received same oral drugs, but Liu briefly defined it as ESWT versus oral medication and conducted a subgroup analysis based on it.…”

“…The 22 studies comprised 13 [9][10][11]14,17,20,[24][25][26][27][28][29][30] in Chinese and 9 in English, 20 [1][2][3][4][5][6][7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33][34][35] were journal articles, 2 [14,27] were www.md-journal.com master's theses, and 1749 patients were involved, with 881 and 868 patients in the experimental and control groups, respectively. Twenty-two studies were RCTs, all of which stated that "there was no statistically significant difference between the baseline of the experimental group and control group (P > .05)."…”

“…[ 4 ] Lei [ 5 ] made the first meta-analysis of ESWT for LBP in 2021, while Liu [ 6 ] systematic review in 2023 assessed mental health scores for the first time. However, there are contradictions in these studies; Lei [ 5 ] and Li [ 7 ] thought that the long-term efficacy of ESWT in patients with LBP was insignificant, but Liu [ 6 ] thought it was considerable. In addition, previous systematic reviews had some issues and errors, such as failure to investigate the impact of differences in treatment parameters and duration due to the small number of included studies, [ 5 ] failure to discuss the long-term efficacy of ESWT due to a small number of studies, [ 8 ] errors in the table of characteristics of the included studies, [ 7 ] and lack of methodological rigor in the grouping for subgroup analysis.…”

“…However, there are contradictions in these studies; Lei [ 5 ] and Li [ 7 ] thought that the long-term efficacy of ESWT in patients with LBP was insignificant, but Liu [ 6 ] thought it was considerable. In addition, previous systematic reviews had some issues and errors, such as failure to investigate the impact of differences in treatment parameters and duration due to the small number of included studies, [ 5 ] failure to discuss the long-term efficacy of ESWT due to a small number of studies, [ 8 ] errors in the table of characteristics of the included studies, [ 7 ] and lack of methodological rigor in the grouping for subgroup analysis. [ 6 ] Due to the continuous updating of studies, controversial results, and the small number of systematic reviews on ESWT for LBP, this study aimed to systematically evaluate the effectiveness and safety of ESWT for LBP again by meta-analysis to judge the quality of evidence objectively and rigorously and to provide high-quality evidence for LBP.…”