Effects of Repeated Injection of 1% Lidocaine vs. Radial Extracorporeal Shock Wave Therapy for Treating Myofascial Trigger Points: A Randomized Controlled Trial

Trigger point injections for myofascial pain in terminal cancer: a randomized trial

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of a single trigger point injection (TPI) of a local anesthetic for the treatment of myofascial pain syndrome (MPS) in patients with incurable cancer.

METHODS

This multicenter, exploratory, open-label, randomized comparative trial was conducted in five specialized palliative care departments. Hospitalized patients with incurable cancer who had been experiencing pain related to MPS were randomized to receive either a TPI of 1% lidocaine plus conventional care (TPI group) or conventional care alone (control group). The short-term efficacy and occurrence of adverse events (AEs) were compared between groups. The primary endpoint was the percentage of patients who experienced a reduction in pain scores of ≥50%, assessed using an 11-point Numerical Rating Scale, at 3 days post-intervention. Adverse events were assessed using the Common Terminology Criteria for AEs v5.0.

RESULTS

Fifty patients were enrolled, and the trial completion rate was 100%. The proportion of patients who experienced an improvement in Numerical Rating Scale pain scores of ≥50% was 70.8% (95% confidence interval, 52.4%-89.2%) in the TPI group and 0.0% in the control group; the difference was statistically significant (P < .001). In the TPI group, one case (4.2%) of Grade 1 nausea and 1 case (4.2%) of Grade 1 somnolence were reported.

CONCLUSION

A single TPI of a local anesthetic is safe and efficacious in inducing an immediate reduction in MPS-related pain in patients with incurable cancer. Clinical trials registration number: This study was registered with the Japan Registry of Clinical Trials (approval number: jRCTs051210132) on December 16, 2021. https://jrct.niph.go.jp/en-latest-detail/jRCTs051210132.Approval of the research protocol by a Certified Review Board: The present study was approved by the Wakayama Medical University (reference number: CRB5180004. Registered 26 May 2021).

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.

Study on the effect, safety, prognosis quality and application value of extracorporeal shock wave based neural activity in carpal tunnel syndrome patients

BACKGROUND

Mild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization.

METHODS

The clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed.

RESULTS

The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P < 0.05). ADL scores are negatively correlated.

CONCLUSION

Extracorporeal shock wave combined with nerve mobilization has a significant effect in the treatment of CTS patients, which can significantly improve the symptoms and pain scores of patients, and enhance the function of patients' upper limbs. At the same time, the incidence of complications in patients is less, and it has high safety.

The Effects of the Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves

Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies address the molecular and cellular mechanisms of action of ESWT. However, to date, no uniform concept could be established on this matter. In the present study, we perform a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results are as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT is described in a study does not automatically mean that this mechanism is relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.