Patient-friendly summary
If you read nothing else
Bottom line
ESWT shows promise for treating myofascial pain and is worth discussing with your provider.
Moderate evidenceAsk your provider
- What are the benefits and risks of ESWT for my condition?
- How many sessions would I need, and how long are they?
- What can I expect the recovery to be like after ESWT?
Try this week
- Ask your provider about ESWT as a possible treatment for myofascial pain.
How well it works
ESWT was found to be more effective than other treatments in reducing pain and disability index in patients with MPS.
Words decoded
- Myofascial pain syndrome (MPS)
- — A type of muscle pain caused by trigger points that can cause pain in one area or all over the body.
- Extracorporeal shock wave therapy (ESWT)
- — A treatment that uses high-energy sound waves to help break up muscle knots and reduce pain.
- Trigger points
- — Sensitive spots in the muscles that, when pressed, can cause pain in other areas of the body.
Full research — for clinicians and curious readers
Study Summary
Background
Myofascial pain syndrome (MPS) is a common musculoskeletal condition characterized by painful trigger points in muscles that cause local and referred pain. Traditional treatments include trigger point injections, dry needling, electrical stimulation, and ultrasound therapy. Extracorporeal shock wave therapy (ESWT) has emerged as a non-invasive physical therapy option that uses high-energy mechanical waves to treat various musculoskeletal conditions. While individual studies have shown promise for ESWT in treating MPS, there has been limited systematic evaluation of its effectiveness compared to other established treatments.
What They Did
The researchers conducted a comprehensive systematic review and meta-analysis by searching major medical databases (PubMed, Embase, Cochrane, Web of Science) through October 2021. They included 8 controlled clinical studies involving 571 patients with myofascial pain syndrome. Most patients (541) had neck and upper back pain, while 30 had lower back pain. The studies compared ESWT to various control treatments including trigger point injection, dry needling, ultrasound therapy, electrical stimulation, and kinesiology taping.
They assessed study quality using the PEDro scale and analyzed outcomes including pain intensity (Visual Analog Scale), pressure pain threshold, and neck disability index. Statistical analysis was performed using RevMan 5.4 software with appropriate tests for heterogeneity.
What They Found
The meta-analysis revealed significant benefits for ESWT compared to other treatments. Pain levels after ESWT were substantially lower than other treatments (mean difference = -1.34 on VAS scale, 95% CI: -1.87 to -0.81, P<0.00001). Pressure pain threshold, which measures how much pressure is needed to cause pain, was higher after ESWT treatment (mean difference = 0.90, 95% CI: 0.73 to 1.07, P<0.00001), indicating less sensitivity to pressure. The neck disability index, measuring functional impairment, was also significantly lower after ESWT (mean difference = -1.79, 95% CI: -2.48 to -1.10, P<0.00001).
All results showed strong statistical significance, though there was heterogeneity between studies due to different patient characteristics and treatment protocols.
What This Means
This meta-analysis provides strong evidence that ESWT is more effective than several established treatments for myofascial pain syndrome. The therapy offers significant advantages as a non-invasive option that avoids the potential complications and patient tolerance issues associated with injections or needling procedures. For patients with neck, shoulder, and upper back trigger points, ESWT appears to provide meaningful pain relief and functional improvement. Clinicians can consider ESWT as a first-line treatment option, particularly for patients who prefer non-invasive approaches or have concerns about needling procedures.
The therapy's ability to improve both pain and function makes it a valuable addition to the treatment arsenal for myofascial pain syndrome.
- Total Patients Analyzed
- 571
- Statistical Significance
- p<0.00001
- Studies Included
- 8
Results Comparison
Pain Reduction (VAS Scale)
points lowerKey Findings
| Finding | Detail | Impact |
|---|---|---|
| ESWT significantly reduced pain compared to all other treatments | Mean difference of -1.34 points on VAS scale (95% CI: -1.87 to -0.81, P<0.00001) | High |
| Pressure pain threshold improved more with ESWT | Mean difference of 0.90 (95% CI: 0.73 to 1.07, P<0.00001), indicating less pain sensitivity | High |
| Functional disability improved significantly with ESWT | Neck Disability Index was 1.79 points lower (95% CI: -2.48 to -1.10, P<0.00001) | High |
| Benefits were consistent across different control treatments | ESWT showed superiority over trigger point injection, dry needling, ultrasound, and TENS | Medium |
| Most evidence focused on neck and upper back pain | 541 of 571 patients had cervical/upper back MPS, with limited data on other regions | Medium |
Strengths
- Comprehensive search of multiple major databases
- Used rigorous statistical methods with appropriate heterogeneity testing
- Included only controlled clinical trials for higher evidence quality
- Assessed multiple clinically relevant outcome measures
Limitations
- High heterogeneity between studies due to different protocols and populations
- Limited evidence for body regions other than neck and upper back
- Some included studies had methodological concerns with randomization and blinding
- Short follow-up periods in most studies (4-6 weeks)
Key Takeaways for Patients
What This Means for You
ESWT appears to be more effective than traditional treatments for trigger point pain in the neck and shoulders
This treatment doesn't require needles or injections, making it a good option if you're uncomfortable with invasive procedures
You may experience significant pain relief and better function within 4-6 weeks of treatment
The treatment appears to be safe with no major side effects reported in the studies
Talk to your healthcare provider about whether ESWT is available and appropriate for your specific condition
Read the Full Paper
Access the complete peer-reviewed study from Annals of Translational Medicine