Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia

Abstract

Chronic muscle pain syndrome is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used in the past to describe painful muscular syndromes in the absence of evident local nociception such as myogelosis, muscle hardening, myalgia, muscular rheumatism, fibrositis or myofascial trigger point with or without referred pain. If it persists over six months or more, it often becomes therapy resistant and frequently results in chronic generalized pain, characterized by a high degree of subjective suffering. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibers, known as myofascial trigger points (MTP), and fascial constrictions. Fibromyalgia (FM) is a chronic condition that involves both central and peripheral sensitization and for which no curative treatment is available at the present time. Fibromyalgia shares some of the features of MPS, such as hyperirritability. Many treatments options have been described for muscle pain syndrome, with differing evidence of efficacy. Extracorporeal Shockwave Treatment (ESWT) offers a new and promising treatment for muscular disorders. We will review the existing bibliography on the evidence of the efficacy of ESWT for MPS, paying particular attention to MTP (Myofascial Trigger Point) and Fibromyalgia (FM).

Update of Extracorporeal Shockwave Therapy in Myofascial Pain Syndrome

“…[9][10][11][12][13][14] Extracorporeal Shock Wave Therapy (ESWT) can be nowadays approved as an effective, safe, noninvasive therapy for many musculoskeletal diseases and many conditions where regenerative effects are desirable. It is the novel therapy for applications in the fields of regenerative medicine, tissue engineering and cell therapies.…”

“…[9][10][11][12][13][14] b. Shock waves effect on soft tissue and musculoskeletal tissue are as the follows i.…”

“…Animal studies show that ESWT has an influence on pain transmission by acting on substance P, calcitonin gene-related peptide (CGRP) expression in the dorsal root ganglion and on neurovascular sprouting. [9][10][11][12][13][14][18][19][20][21][22][23] ESWT uses biphasic acoustic energy that goes from positive high peak pressures (10-100 MPa (mega pascals) for fESWT;0.1-1 MPa for rESWT) to negative phase (10 MPa); short rise times (10-100 ns for F-ESWT;0.5-1 ms for rESWT), short duration (0.2-0.5 ms for fESWT;0.2-0.5 ms for rESWT). Focused and radial shockwaves are generated in different ways.…”

“…Extracorporeal shockwave therapy (ESWT). [9][10][11][12][13][14] And High Intensity Laser (HTL) 15 also play a role as desensitization. Kinesio Taping (KT) 16 and Fascial manipulation 17 are increasing evidences support.…”

Novel Approaches for Chronic Pain

“…Moreover, there are evidences of free nerve endings degeneration and transient dysfunction of nerve excitability at the neuromuscular junction, a pure mechanism of breaking-up the actin myosin links with the overstimulation lead to a diminished transmission of pain signals to the brainstem. For pain transmission, in animal studies revealed substance P, calcitonin gene-related peptide (CGRP) expression in the dorsal root ganglion and on neurovascular sprouting [12][13][14][15][16][17][18][19][20][21][22].…”