Rahbar M, Samandarian M, Salekzamani Y, et al. Effectiveness of extracorporeal shock wave therapy versus standard care in the treatment of neck and upper back myofascial pain: a single blinded randomised clinical trial. Clin Rehabil. 2020 Jul 30:269215520947074. doi: 10.1177/0269215520947074. (Original study)

OBJECTIVES: To compare the efficacy of extracorporeal shock wave therapy versus standard care (ultrasound + hot pack + self-stretch-exercises) in treatment of neck and upper back myofascial pain syndrome.

DESIGN: Single-blind randomised clinical trial.

SETTING: Outpatients setting.

SUBJECTS: Patients with neck and upper back myofascial pain.

INTERVENTION: Participants were randomly allocated into shock wave group (n = 24), standard care (ultrasound + hot pack + self-stretch-exercises) group (n = 24) and control (self-stretch-exercises) group (n = 24) for four weeks.

MAIN MEASURES: The primary outcomes were pain intensity (visual analogue scale), pain pressure threshold (algometer) and disability (neck disability index). Measures were performed at baseline (week 0), week 1 and post-intervention (week 4).

RESULTS: Shock wave and ultrasound improved visual analogue scale (7.50 ± 1.71 to 5.72 ± 2.20 and 6.22 ± 2.54 to 4.95 ± 2.86, respectively, P = 0.083) and disability index (54.24 ± 15.53 to 39.04 ± 19.58 50.23 ± 19.57 to 32.10 ± 18.34, respectively, P = 0.495) similarly at first week examinations that were significantly higher than control (P < 0.05). In week 4 measurements, additional improvements were achieved concerning visual analogue scale and disability index in the shock wave (-4.00 ± 2.22 and -20.24 ± 16.56, respectively) and ultrasound (-2.18 ± 2.71 and -21.79 ± 10.56, respectively) groups. However, visual analogue scale improved more significantly in shock wave group than ultrasound group in fourth week measurements (P = 0.012).

CONCLUSION: Extracorporeal shock wave therapy was more effective in controlling of the pain intensity compared to ultrasound one month after treatment. However it had no superiority over ultrasound in improving neck disability index at this time point.Trial, IRCT201608154104N5, registered 2016-09-25.

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 4 / 7
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Comments from MORE raters

Physician rater

These are interesting, but somewhat conflicting, results.

Rehab Clinician (OT/PT) rater

Extracorporeal shock wave seems got be more effective in decreasing pain. This only has a relative value as it has not been demonstrated before the US is a significant useful modality to manage pain. Extracorporeal shock wave has no effect on the subjects neck disability index scores. Based on this study Extracorporeal shock wave has limits clinical applicability and could be considered as a palliative intervention.

Rehab Clinician (OT/PT) rater

The conclusions of the article reflect the relevance and newsworthiness of this research. Extracorporeal shock wave therapy was more efficient than ultrasound in alleviating pain intensity at fourth week of treatment. However, extracorporeal shock wave was not better than ultrasound in improving neck disability index at this time point. Further studies with different treatment protocol concerning dosage, frequency, duration and application locates are required to generalise and confirm these findings in patients with myofascial pain syndrome.

Rehab Clinician (OT/PT) rater

The use of extracorporeal shock waves is not common place in most US outpatient physical therapy clinics. The finding that there were no functional differences in neck disability after one month using this modality compared to other standards of care does not currently support the expense of buying this equipment.
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