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

Abstract

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 registration www.irct.ir , IRCT201608154104N5, registered 2016-09-25