Extracorporeal Shockwave Therapy for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Objective. To assess the effectiveness and safety of extracorporeal shockwave therapy (ESWT) for the treatment of chronic low back pain (CLBP). Methods. This was a systematic review and meta-analysis of randomized controlled trials (RCTs) designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standard. We identified relevant studies by searching multiple electronic databases, trial registries, and websites up to April 30, 2021, and examining reference lists. We selected RCTs that compared ESWT, in unimodal or multimodal therapeutic approaches, with sham ESWT or other active therapies. Two investigators independently extracted data and assessed the risk of bias and quality of the evidence. The main outcomes were pain intensity and disability status, examined as standardized mean differences (SMD) with 95% confidence intervals (CI). The risk of bias was assessed by using Cochrane Back and Neck (CBN) Group risk of bias tool and Jadad score, and GRADE was applied to determine the confidence in effect estimates. Heterogeneity was explored using sensitivity analysis and meta-regression. Results. Ten RCTs, including a total of 455 young to middle-aged individuals (29.2–55.8 years), were identified. Compared with control, the ESWT group showed lower pain intensity at month 1 ( SMD = − 0.81 , 95% CI −1.21 to −0.42), as well as lower disability score at month 1 ( SMD = − 1.45 , 95% CI −2.68 to −0.22) and at month 3 ( SMD = − 0.69 , 95% CI −1.08 to −0.31). No serious shockwave-related adverse events were reported. Conclusion. The use of ESWT in CLBP patients results in significant and quantifiable reductions in pain and disability in the short term. However, further well-conducted RCTs are necessary for building high-quality evidence and promoting the application of ESWT in clinical practice.

Extracorporeal shockwave therapy improves pain and function in subjects with chronic low back pain: a systematic review and meta-analysis of randomized clinical trials

“…According to our information, there was only one previous meta-analysis about the application of ESWT in CLBP, but we found that this study had high heterogeneity in both pain and dysfunction index analyses, and no subgroup analysis or sensitivity analysis was conducted [27]. In addition, we found that this previous meta-analysis included an unpublished master's thesis and a study of participants with postpartum low back pain that may have affected the reliability of the results and were excluded from our study.…”

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

“…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)."…”

Effect of Shockwave Therapy on Postmenopausal Sacroiliac Joint Pain: A Randomized Controlled Trial

“…Shockwave therapy is a novel conservative method of treatment for musculoskeletal pain produced by a range of illnesses [9] . Since it inhibits pain transmission and suppresses the inflammatory response, it is considered a good choice for alleviating lumbo-pelvic pain and enhancing its function in recent years [10][11][12] . Although menopause is a difficult time for most women and its symptoms have a significant influence on their well-being and life quality [13] , research regarding the benefit of physical therapy interventions on postmenopausal sacroiliac joint pain is lacking.…”