Effects of Shock Wave Therapy on Myofascial Pain Syndrome of Neck and Shouder: A Systematic Review and Meta-Analysis

The purpose of this meta-analysis was to assess the effect of ESWT on pain and functionality in the individuals diagnosed with MPS affecting the neck and shoulder.

A systematic search of PubMed, EMBASE, and Web of Science databases was conducted, covering the period from their inception to August 2023. This review includes the randomized controlled trials comparing the effects of ESWT with other conventional therapies on MPS of the neck and shoulder. Data of the study participants, treatments, follow-up, and outcomes were extracted. The main outcome was the pain, as assessed by visual analog scale (VAS) and pressure pain threshold (PPT), and function, as evaluated by neck disability index (NDI). The quality of the included studies was assessed using the PEDro scale, and the analysis was performed using RevMan 5.4 software.

This study included 13 randomized controlled trials (n=677 patients). Of which, 3 trials had low bias risk, 6 had some concerns, and 4 had high bias risk. The effectiveness of ESWT for MPS-induced pain was superior to that of control groups on the VAS (MD=-0.08, 95% CI=-1.47 to -0.13) and PPT (MD=0.59, 95% CI=0.01 to 1.17), as well as function on the NDI (MD=2.70, 95% CI=-4.31 to -1.09). For the ESWT doses, the medium-energy (P0.01) was much more effective than other energy doses (MD=-1.85, 95% CI=-2.59 to -1.11) on the pain relief and functional improvement.

ESWT effectively decreases the MPS-induced pain and improves the function in the patients with MPS of neck and shoulder. It has been shown that the medium-energy (0.1-0.2 mJ/mm²) of ESWT exhibits more effective roles than other energy does. The long-term beneficial effect of ESWT on MPS has not been proved, and the heterogeneity of included studies in the dose of ESWT impeded the standardization of ESWT in the treatment of MPS. Therefore, the high-quality controlled clinical studies with long-term follow-up are needed to promote the evidence-based treatment of ESTW for MPS.

The use of medium-energy of ESWT as an adjunctive therapeutic method to conventional treatments appears to be a potentially ideal strategy for managing MPS, a condition with a substantial impact on public health.The use of medium-energy of ESWT as an adjunctive therapeutic method to conventional treatments appears to be a potentially ideal strategy for managing MPS, a condition with a substantial impact on public health.