ComparisonoftheEfficacyofLaserandExtracorporealShockwaveTherapyinPatientswithMyofascialPainSyndrome

Myofascial pain syndrome (MPS) is a common and often debilitating condition characterized by hypersensitive trigger points in muscles that cause pain, spasm, limited movement, and tenderness. It affects a substantial portion of the population, with prevalence estimates up to 54% in women and 45% in men, most commonly between ages 30 and 60. The neck-shoulder region and back are frequently affected areas. Treatment options for MPS are diverse, ranging from exercises and manual therapies to various physical modalities and pharmacological agents.

Among these, laser therapy and extracorporeal shockwave therapy (ESWT) have gained attention as non-invasive treatment options. Laser therapy has been used for many years with proposed bio-stimulant, analgesic, and anti-inflammatory effects, while ESWT has emerged more recently as a promising modality that uses high-amplitude sound waves. Despite their growing use, direct comparisons of these two treatments in MPS have been limited, leaving clinicians uncertain about which modality to choose. This study aimed to fill that gap by directly comparing laser and ESWT when combined with exercise in patients with MPS.

The researchers conducted a prospective randomized study involving 40 patients diagnosed with MPS according to established clinical criteria. Participants had experienced symptoms for at least three months and had not received treatment in the previous month. Patients were randomly assigned to one of two groups. The laser group received 15 sessions of laser therapy over three weeks using a Ga-As laser at 904 nm wavelength for 30 seconds per session, applied to the two most sensitive trigger points in either the trapezius or paraspinal muscles.

The ESWT group received three sessions of shockwave therapy at one-week intervals, also applied to the two most sensitive trigger points in the same muscle groups, using 10-15 Hz frequency, 2.0 bar pressure, and 2000 shock pulses per session. Both groups also performed a home exercise program consisting of posture, range of motion, and stretching exercises, three sets of ten repetitions daily for two months. Patients were evaluated before treatment, immediately after treatment completion, and at one month follow-up. Assessments included pain intensity using the Visual Analogue Scale (VAS), pressure pain threshold using an algometer, quality of life using the Short Form-36 (SF-36), and depression levels using the Beck Depression Inventory (BDI).

Both treatment groups showed statistically significant improvements in pain levels. In the laser group, mean VAS scores decreased from 6.8 ± 1.3 before treatment to 4.3 ± 1.5 after treatment and further to 3.1 ± 2.0 at one month follow-up (P < .001). In the ESWT group, mean VAS scores decreased from 7.1 ± 1.9 to 5.2 ± 1.9 after treatment and to 3.9 ± 2.6 at one month (P < .001). Pressure pain threshold improved in both groups at one month compared to baseline, with the laser group increasing from 2.5 ± 1.0 to 3.7 ± 1.1 kg and the ESWT group from 2.1 ± 0.9 to 3.5 ± 1.3 kg (both P < .001).

Both groups also showed improvements in depression scores and SF-36 physical component scores from baseline to one month. However, the SF-36 mental component did not show statistically significant changes from before to after treatment in either group. Crucially, when the researchers compared the two groups directly, they found no statistically significant differences between laser and ESWT in any outcome measure at any time point. This means that while both treatments worked, neither proved superior to the other.

For patients with myofascial pain syndrome, this study offers reassuring news that both laser therapy and extracorporeal shockwave therapy can provide meaningful pain relief and improved quality of life when combined with exercise. The similar effectiveness of these two treatments gives patients and clinicians flexibility in choosing an approach based on factors like availability, cost, convenience, and personal preference. The exercise component appears important, as both groups performed consistent home exercises alongside their primary treatment. For clinicians, these findings suggest that either modality can be recommended without concern that one is markedly better than the other.

The shorter treatment course with ESWT (three sessions versus fifteen for laser) might appeal to patients with limited time or access to care, though this practical advantage was not formally tested. The lack of a control group receiving exercise alone means we cannot determine how much of the improvement came from the physical modalities versus the exercise program itself. Future research with larger samples, longer follow-up periods, and exercise-only control groups would help clarify the specific contributions of each treatment component.