Back CGN, Peron R, Lopes CVR, et al. Immediate effect of extracorporeal shockwave therapy in patients with chronic non-specific low back pain: A randomised placebo-controlled triple-blind trial. Clin Rehabil. 2024 May 6:2692155241251844. doi: 10.1177/02692155241251844. (Original study)

OBJECTIVE: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain.

DESIGN: Randomised placebo-controlled study with three intervention groups.

SETTING: The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022.

PARTICIPANTS: Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for =3 months and pain intensity =3 were randomly recruited for the study.

INTERVENTION: The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment.

MAIN MEASURES: The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention.

RESULTS: The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, -0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group.

CONCLUSION: The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
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Comments from MORE raters

Physician rater

According to the study's findings, patients with chronic non-specific low-back pain who receive focused radial shockwave therapy have a higher pain threshold and experience less pain than those who receive non-focused or placebo-treated radial shockwave therapy. However, the inability of the therapist to blind the techniques is a drawback of the study. Also, the results were only achieved at one site, so care should be taken when extrapolating the findings. Additionally, concurrent treatments were not monitored with the exception of analgesic and anti-inflammatory medications, and the outcomes were not evaluated in a long-term follow-up.

Physician rater

According to the trialists, focused radial shockwave therapy is superior to placebo and non-focused radial shockwave therapy in alleviating pain and reducing local hyperalgesia in patients with chronic non-specific low-back pain. However, the failure of the therapist to blind the techniqu raises concerns about potential bias. Additionally, the generalizability of the findings may be limited, as the study was conducted at a single center. Future research should aim to replicate these results in multi-center trials with larger sample sizes and longer follow-up periods to assess the durability of the treatment effects. Investigating the optimal treatment parameters, such as energy density and number of sessions, would also be valuable in optimizing the therapeutic potential of focused radial shockwave therapy for chronic low-back pain.

Rehab Clinician (OT/PT) rater

This study gives me insight into the effectiveness of shockwave therapy in patients with chronic low back pain. Few primary care practices in the Netherlands have shockwave therapy available, so most practicing therapists are not aware of this type of intervention and the results of this study, which is the first randomized study protocol.

Rehab Clinician (OT/PT) rater

The study design is poor and the low sample size does not support bringing the use of ESWT into common practice as a first line for back pain management. There are other nociceptice techniques and modalities that are lower cost and carry less risk as a first line in management of non-chronic LBP.
Comments from PAIN+ CPN subscribers

Dr. Hélène Bertrand (5/31/2024 12:43 PM)

In addition to no blinding and no long-term assessment, most physicians do not have the materials needed to administer extracorporeal shockwave therapy. A much simpler, less time-consuming, and more effective is to assess the levels of the PSISs since most nonspecific low back pain is the result of displaced pelvic bones on the sacroiliac joints. Once the degree and direction of displacement is known, the treatment becomes obvious. The 2-minute corrective exercise has a 90% success rate in providing relief. The patient is then able to relieve his/her pain as needed. Check out this article: DOI: 10.7759/cureus.19483