Predictive factors of response in radial Extracorporeal Shock-waves Therapy for Myofascial and Articular Pain: A retrospective cohort study

No dose response effect in shockwave therapy applied to bone conditions: a systematic review, meta-analysis and meta-regression

Background

Shock waves have been widely used to treat bone conditions, but despite the articles and meta-analyses, there are still doubts about its effectiveness, with a meta-analysis pointing to uncertain evidence of positive effects for pain and delayed or non-union, while others point to a positive effect on the same outcomes. One hypothesis for this conflict in the results is the lack of research on the relationship between the applied dose and clinical outcomes.

Purpose

Identify the effect of the dose applied in shockwave therapy on clinical results in bone conditions by meta-regression of controlled trials.

Methods

Our search was conducted on PubMed (MEDLINE), EMBASE, Cochrane, Web of Science and Scopus in November 2022. The results of 3, 6, 12 and 24 months, post treatment of shockwave therapy of long bone fractures, osteonecrosis of femoral head and bone marrow edema were analyzed for pain, functional scores, size of lesion and non-union with meta-analysis and meta-regressions were conducted with the clinical results and the parameters of the quantity of pulses and energy flux density (EFD).

Results

3641 studies were retrieved and after the selection process eight of them were included for analyses. Shockwave therapy applied at the moment of surgery led to significant lower raw mean difference (RMD) pain scores at six months (RMD: -1.53[-2.58; -0.48], p=0.004) and at 3 and 12 months. Better functional standard mean difference (SMD) scores were found at six months (SMD: 0.83[0.32; 1.33], p<0.001) and at 3 and 24 months. A reduction in the size of lesion for the osteonecrosis of the femoral head was found at 12 months (RMD: -19.01[-35.63; -2.39], p=0.02). The meta-regression analyses showed no association between EFD (R2=0.00; p=0.42), or the number of pulses (R2=0.00; p=0.36) with pain scores; or EFD (R2=0.00; p=0.75), and the number of pulses (R2=0.00; p=0.65) with functional values.

Discussion

The results point that shockwave therapy had positive effects in pain and functional scores at different time points after bone fractures or osteonecrosis of the femoral head, however, neither the quantity of pulses or the energy flux density showed any relationship with these positive outcomes.

The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review

BACKGROUND

Myofascial pain syndrome (MPS) is a common musculoskeletal pain and dysfunction, which is characterised by myofascial trigger points. Therapeutic physical modalities, as potentially effective treatment options, are commonly used in the clinical setting for the patients with MPS.

OBJECTIVE

This systematic review aimed to evaluate the safety and effectiveness of therapeutic physical modalities in the treatment of MPS, investigate its therapeutic mechanisms and provide a scientific evidence-based decision.

METHODS

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Cochrane Central Library, Embase, and CINAHL databases were searched for randomized controlled clinical studies published from database inception to October 30, 2022. A total of 25 articles met the study inclusion criteria. Data were extracted from these studies and a qualitative analysis was performed.

RESULTS

Transcutaneous electrical nerve stimulation therapy, extracorporeal shock wave therapy, laser therapy, and other therapeutic physical modalities have been demonstrated to improve the pain symptoms, joint mobility, psychological state, and quality of life in the patients with MPS and no side effects have been reported. The curative effect of therapeutic physical modalities was found to be possibly associated with increased blood perfusion and oxygen supply in ischaemic tissues, reduced hyperalgesia in the peripheral and central nerves, and decreased involuntary muscle contractions.

CONCLUSION

The systematic review has shown that therapeutic physical modalities could provide a safe and effective therapeutic option for MPS. However, the consensus is currently lacking regarding the optimal treatment paradigm, therapeutic parameters, and mutual combination of therapeutic physical modalities. The clinical trials with robust quality are required to further promote the evidence-based application of therapeutic physical modalities for MPS.

Efficacy and Effectiveness of Extracorporeal Shockwave Therapy in Patients with Myofascial Pain or Fibromyalgia: A Scoping Review

Myofascial pain syndrome (MPS) and fibromyalgia (FM) are underestimated painful musculoskeletal conditions that could impact function and quality of life. A consensus about the most appropriate therapeutic approach is still not reached. Considering the long course of the diseases, prolonged assumption of drugs, such as NSAIDs and pain killers, could increase the risk of adverse events, often leading affected patients and physicians to prefer non-pharmacological approaches. Among these, radial and focused extracorporeal shock waves therapies (ESWT) are widely used in the management of painful musculoskeletal conditions, despite the fact that the mechanisms of action in the context of pain modulation should be further clarified. We performed a scoping review on PubMed using Mesh terms for analyzing the current evidence about the efficacy and effectiveness of ESWT for patients with MPS or FM. We included 19 clinical studies (randomized controlled trials and observational studies); 12 used radial ESWT, and 7 used focused ESWT for MPS. Qualitative analysis suggests a beneficial role of ESWT for improving clinical and functional outcomes in people with MPS, whereas no evidence was found for FM. Considering this research gap, we finally suggested a therapeutic protocol for this latter condition according to the most recent diagnostic criteria.