Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study

Yoon Soo Cho, So Young Joo, Huisong Cui, Sung-Rae Cho, Haejun Yim, Cheong Hoon Seo, Yoon Soo Cho, So Young Joo, Huisong Cui, Sung-Rae Cho, Haejun Yim, Cheong Hoon Seo

Abstract

Background: Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients.

Methods: A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm (0.05-0.15 mJ/mm) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores.

Results: The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128).

Conclusion: ESWT significantly reduced scar pain in burn patients after wound recovery.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The extracorporeal shock wave therapy was administered to burn patients. The administered shock wave dose was 100 impulses/cm2 (depending on the burn wound surface area) at 0.05 to 0.15 mJ/mm2 with a total of 1000 to 2000 impulses.
Figure 2
Figure 2
Changes in the Role and Maudsley scores. Among the 20 patients in the ESWT group, 17 (85%) reported a score of poor and 3 (15%) reported fair before ESWT, whereas 3 (15%) reported a score of poor, 8 (40%) reported fair, 5 (25%) reported good, and 4 (20%) reported excellent after ESWT. Among the 20 patients in the control group, 13 (65%) reported a score of poor and 7 (35%) reported fair before ESWT, whereas 5 (25%) reported a score of poor, 12 (60%) reported fair, and 3 (15%) reported good after sham ESWT. The Roles and Maudsley scores significantly improved after ESWT in the ESWT group (∗P = 0.004), but they did not improve in the control group (P = 0.128). There were significant differences between the 2 groups (∗∗P = 0.04). Statistical analysis was performed using the Fisher exact test. Values are presented as a number (%). ESWT = extracorporeal shock wave therapy.

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