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

Marco Paoletta, Antimo Moretti, Sara Liguori, Giuseppe Toro, Francesca Gimigliano, Giovanni Iolascon, Marco Paoletta, Antimo Moretti, Sara Liguori, Giuseppe Toro, Francesca Gimigliano, Giovanni Iolascon

Abstract

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.

Keywords: extracorporeal shockwave therapy; fibromyalgia; musculoskeletal pain; myofascial pain syndromes; neck pain; pressure pain threshold; rehabilitation; trigger points.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the literature review process.
Figure 2
Figure 2
Hypothesized mechanisms of action of ESWT in people with MPS. Abbreviations: Ach, acetylcholine; Ca2+, calcium ion; Pg, prostaglandins; 5HT, 5-hydroxytryptamine.
Figure 3
Figure 3
Hypothesized mechanisms of action of ESWT in people with FM. Abbreviations: ET-1, endothelin 1; CGRP, calcitonin gene-related peptide.

References

    1. Poveda-Pagán E.J., Lozano-Quijada C., Segura-Heras J.V., Peral-Berna M., Lumbreras B. Referred Pain Patterns of the Infraspinatus Muscle Elicited by Deep Dry Needling and Manual Palpation. J. Altern Complement. Med. 2017;23:890–896. doi: 10.1089/acm.2016.0306.
    1. Cao Q.W., Peng B.G., Wang L., Huang Y.Q., Jia D.L., Jiang H., Lv Y., Liu X.G., Liu R.G., Li Y., et al. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J. Clin. Cases. 2021;9:2077–2089. doi: 10.12998/wjcc.v9.i9.2077.
    1. Jin F., Guo Y., Wang Z., Badughaish A., Pan X., Zhang L., Qi F. The pathophysiological nature of sarcomeres in trigger points in patients with myofascial pain syndrome: A preliminary study. Eur. J. Pain. 2020;24:1968–1978. doi: 10.1002/ejp.1647.
    1. Shah J.P., Danoff J.V., Desai M.J., Parikh S., Nakamura L.Y., Phillips T.M., Gerber L.H. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch. Phys. Med. Rehabil. 2008;89:16–23. doi: 10.1016/j.apmr.2007.10.018.
    1. Mazza D.F., Boutin R.D., Chaudhari A.J. Assessmen.nt of Myofascial Trigger Points via Imaging: A Systematic Review. Am. J. Phys. Med. Rehabil. 2021;100:1003–1014. doi: 10.1097/PHM.0000000000001789.
    1. Bair M.J., Krebs E.E. Fibromyalgia. Ann. Intern. Med. 2020;172:ITC33. doi: 10.7326/aitc202003030.
    1. Koppenhaver S.L., Walker M.J., Rettig C., Davis J., Nelson C., Su J., Fernández-de-Las-Peñas C., Hebert J.J. The association between dry needling-induced twitch response and change in pain and muscle function in patients with low back pain: A quasi-experimental study. Physiotherapy. 2017;103:131–137. doi: 10.1016/j.physio.2016.05.002.
    1. Rha D.W., Shin J.C., Kim Y.K., Jung J.H., Kim Y.U., Lee S.C. Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography. Arch. Phys. Med. Rehabil. 2011;92:1576–1580. doi: 10.1016/j.apmr.2011.05.005.
    1. Ryskalin L., Morucci G., Natale G., Soldani P., Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life. 2022;12:743.e1. doi: 10.3390/life12050743.
    1. Aschermann I., Noor S., Venturelli S., Sinnberg T., Mnich C.D., Busch C. Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers. Cell Physiol Biochem. 2017;41:890–906. doi: 10.1159/000460503.
    1. Simplicio C.L., Purita J., Murrell W., Santos G.S., Dos Santos R.G., Lana J.F.S.D. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J. Clin. Orthop Trauma. 2020;11:S309–S318. doi: 10.1016/j.jcot.2020.02.004.
    1. Tricco A.C., Lillie E., Zarin W., O’Brien K.K., Colquhoun H., Levac D., Moher D., Peters M.D.J., Horsley T., Weeks L., et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann. Intern. Med. 2018;169:467–473. doi: 10.7326/M18-0850.
    1. Taheri P., Vahdatpour B., Andalib S. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius. Adv. Biomed. Res. 2016;5:138. doi: 10.4103/2277-9175.187398.
    1. Király M., Bender T., Hodosi K. Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius. Rheumatol. Int. 2018;38:2045–2052. doi: 10.1007/s00296-018-4134-x.
    1. Aktürk S., Kaya A., Çetintaş D., Akgöl G., Gülkesen A., Kal G.A., Güçer T. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: Randomized, sham-controlled study. J. Phys. Ther Sci. 2018;30:448–453. doi: 10.1589/jpts.30.448.
    1. Rahbar M., Samandarian M., Salekzamani Y., Khamnian Z., Dolatkhah N. 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. 2021;35:102–113. doi: 10.1177/0269215520947074.
    1. Gezgİnaslan Ö., GÜmÜŞ Atalay S. High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial. Arch. Rheumatol. 2019;35:78–89. doi: 10.5606/ArchRheumatol.2020.7496.
    1. Taheri P., Naderi M., Khosravi S. Extracorporeal Shock Wave Therapy Versus Phonophoresis Therapy for Neck Myofascial Pain Syndrome: A Randomized Clinical Trial. Anesth Pain Med. 2021;11:e112592. doi: 10.5812/aapm.112592.
    1. Walsh R., Kinsella S., McEvoy J. The effects of dry needling and radial extracorporeal shockwave therapy on latent trigger point sensitivity in the quadriceps: A randomised control pilot study. J. Bodyw. Mov. Ther. 2019;23:82–88. doi: 10.1016/j.jbmt.2018.02.010.
    1. Luan S., Zhu Z.M., Ruan J.L., Lin C.N., Ke S.J., Xin W.J., Liu C.C., Wu S.L., Ma C. Randomized Trial on Comparison of the Efficacy of Extracorporeal Shock Wave Therapy and Dry Needling in Myofascial Trigger Points. Am. J. Phys. Med. Rehabil. 2019;98:677–684. doi: 10.1097/PHM.0000000000001173.
    1. Manafnezhad J., Salahzadeh Z., Salimi M., Ghaderi F., Ghojazadeh M. The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial. J. Back Musculoskelet. Rehabil. 2019;32:811–818. doi: 10.3233/BMR-181289.
    1. Eftekharsadat B., Fasaie N., Golalizadeh D., Babaei-Ghazani A., Jahanjou F., Eslampoor Y., Dolatkhah N. Comparison of efficacy of corticosteroid injection versus extracorporeal shock wave therapy on inferior trigger points in the quadratus lumborum muscle: A randomized clinical trial. BMC Musculoskelet. Disord. 2020;21:695. doi: 10.1186/s12891-020-03714-3.
    1. Li W., Wu J. Treatment of Temporomandibular Joint Disorders by Ultrashort Wave and Extracorporeal Shock Wave: A Comparative Study. Med. Sci Monit. 2020;26:e923461. doi: 10.12659/MSM.923461.
    1. Sugawara A.T., Lima M.D.C., Dias C.B. Predictive factors of response in radial Extracorporeal Shock-waves Therapy for Myofascial and Articular Pain: A retrospective cohort study. J. Back Musculoskelet. Rehabil. 2021;34:485–490. doi: 10.3233/BMR-200152.
    1. Jeon J.H., Jung Y.J., Lee J.Y., Choi J.S., Mun J.H., Park W.Y., Seo C.H., Jang K.U. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Ann. Rehabil. Med. 2012;36:665–674. doi: 10.5535/arm.2012.36.5.665.
    1. Ji H.M., Kim H.J., Han S.J. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius. Ann. Rehabil Med. 2012;36:675–680. doi: 10.5535/arm.2012.36.5.675.
    1. Park K.D., Lee W.Y., Park M.H., Ahn J.K., Park Y. High- versus low-energy extracorporeal shock-wave therapy for myofascial pain syndrome of upper trapezius: A prospective randomized single blinded pilot study. Medicine. 2018;97:e11432. doi: 10.1097/MD.0000000000011432.
    1. Kamel F.H., Basha M., Alsharidah A., Hewidy I.M., Ezzat M., Aboelnour N.H. Efficacy of Extracorporeal Shockwave Therapy on Cervical Myofascial Pain Following Neck Dissection Surgery: A Randomized Controlled Trial. Ann. Rehabil. Med. 2020;44:393–401. doi: 10.5535/arm.20055.
    1. Moghtaderi A., Khosrawi S., Dehghan F. Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial. Adv. Biomed. Res. 2014;3:99. doi: 10.4103/2277-9175.129369.
    1. Hong J.O., Park J.S., Jeon D.G., Yoon W.H., Park J.H. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum. Ann. Rehabil. Med. 2017;41:582–588. doi: 10.5535/arm.2017.41.4.582.
    1. Yalçın Ü. Comparison of the effects of extracorporeal shockwave treatment with kinesiological taping treatments added to exercise treatment in myofascial pain syndrome. J. Back Musculoskelet. Rehabil. 2021;34:623–630. doi: 10.3233/BMR-200234.
    1. Gerwin R. Botulinum toxin treatment of myofascial pain: A critical review of the literature. Curr. Pain. Headache Rep. 2012;16:413–422. doi: 10.1007/s11916-012-0287-6.
    1. Ramon S., Gleitz M., Hernandez L., Romero L.D. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. Int J. Surg. 2015;24:201–206. doi: 10.1016/j.ijsu.2015.08.083.
    1. Travell J.G., Simons D.G. Myofascial Pain Dysfunction the Trigger Point Manual. 2nd ed. Williams & Wilkins; Baltimore, MD, USA: 1999.
    1. Sarzi-Puttini P., Giorgi V., Marotto D., Atzeni F. Fibromyalgia: An update on clinical characteristics, aetiopathogenesis and treatment. Nat. Rev. Rheumatol. 2020;16:645–660. doi: 10.1038/s41584-020-00506-w.
    1. Grayston R., Czanner G., Elhadd K., Goebel A., Frank B., Üçeyler N., Malik R.A., Alam U. A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis. Semin. Arthritis Rheum. 2019;48:933–940. doi: 10.1016/j.semarthrit.2018.08.003.
    1. Sorg H., Zwetzich I., Tilkorn D.J., Kolbenschlag J., Hauser J., Goertz O., Spindler N., Langer S., Ring A. Effects of Extracorporeal Shock Waves on Microcirculation and Angiogenesis in the in vivo Wound Model of the Diver Box. Eur. Surg. Res. 2021;62:134–143. doi: 10.1159/000515737.
    1. Hausdorf J., Lemmens M.A., Heck K.D., Grolms N., Korr H., Kertschanska S., Steinbusch H.W., Schmitz C., Maier M. Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system. Neuroscience. 2008;155:138–144. doi: 10.1016/j.neuroscience.2008.03.062.
    1. Wolfe F., Clauw D.J., Fitzcharles M.A., Goldenberg D.L., Häuser W., Katz R.L., Mease P.J., Russell A.S., Russell I.J., Walitt B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016;46:319–329. doi: 10.1016/j.semarthrit.2016.08.012.

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