Noori SA, Rasheed A, Aiyer R, et al. Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review. Pain Med. 2019 Jan 12. pii: 5288719. doi: 10.1093/pm/pny287. (Systematic review)

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Physician rater

Therapeutic ultrasound is often used in the treatment of pain conditions including low back and neck pain without any good evidence of efficacy. This systematic review looked at randomised controlled trials which included therapeutic ultrasound in the management of low back and neck pain. The authors identified ten RCTs that met the inclusion criteria. Unfortunately the studies were not of great quality and theraputic ultrasound was often used in addition to other therapies making it almost impossible to determine what role therapeutic ultrasound had in any improvement seen. The conclusion of this systematic review was that the use of only therapeutic ultrasound in the management of chronic low back or neck pain is not supported by the evidence and it remains of unproven efficacy probably best used in combination with other therapies for short term pain relief in patients with low back or neck pain.
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