Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Low back pain (LBP) and neck pain are major causes of pain and disability that are experienced across all ages. The primary goals of treatment are to improve patient function and facilitate a return to the patient’s desired level of daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders, but there continues to be controversy regarding its use due to insufficient evidence of effectiveness. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with chronic LBP and neck pain.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Using PRISMA guidelines, a search of the PubMed and CENTRAL (The Cochrane Library) databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound in patients with chronic LBP or neck pain.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The search strategy identified 10 trials that met the criteria for inclusion. Three studies in LBP reported that both therapeutic and sham (placebo) ultrasound provided significant improvement in pain intensity. In each of these studies, ultrasound was found to be more effective than placebo when using only one of several validated instruments to measure pain. Three of the four studies on neck pain demonstrated significant pain relief with ultrasound in combination with other treatment modalities. However, only one of these studies demonstrated that the use of ultrasound was the cause of the statistically significant improvement in pain intensity.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Therapeutic ultrasound is frequently used in the treatment of LBP and neck pain and is often combined with other physiotherapeutic modalities. However, given the paucity of trials and conflicting results, we cannot recommend the use of monotherapeutic ultrasound for chronic LBP or neck pain. It does seem that ultrasound may be considered as part of a physical modality treatment plan that may be potentially helpful for short-term pain relief; however, it is undetermined which modality may be superior. In both pain syndromes, further trials are needed to define the true effect of low-intensity ultrasound therapy for axial back pain. No conclusive recommendations may be made for optimal settings or session duration.</jats:p> </jats:sec>

Comparison of the effects of low-level laser and pulsed and continuous ultrasound on pain and physical disability in chronic non-specific low back pain: a randomized controlled clinical trial

“…The nonthermal effects of pulsed ultrasound may explain the improvement in functional disability. Stable cavitation consists of gas bubbles which expand and contract due to changes in pressure repeated over many acoustic cycles, representing a kind of micro-massage at the site and reducing muscle spasms [53]. Also, the micro-flow produces tension in highly viscous substances, and can alter the permeability of the cell membrane to sodium and calcium ions, which is important in the tissue healing process [15,18,51,54].…”

The Role of Ultrasound Therapy in the Management of Musculoskeletal Soft Tissue Pain

“…8 In a recent systematic review, it was shown that TUS was no more effective than placebo to treat back pain, whereas it resulted in significant neck pain reduction when combined with other modalities. 26 Similarly, in a systematic review, US was shown to have short-term benefit only in improving low-back function. 27 The authors proposed further studies to elucidate their findings.…”

Боль В Шее: Современные Подходы К Использованию Методов Немедикаментозного Лечения. Часть І

“…There was a recent systemic review [14] on the ultrasound efficacy in the NP treatment. The authors con-Лекції, огляди / Lectures, Reviews ducted their search in PubMed and Cochrane Library and selected 5 RCTs (average number of patients varying from 26 to 102, and the NP duration varying from 3 to 6 months); however, no data was found confirming the significant positive ultrasound effect in the NP patients following their treatment.…”