High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial

Objectives: This study aims to investigate the effects of extracorporeal shock wave therapy (ESWT) on pain, sleep, fatigue, disability, depression, and quality of life (QoL) in patients with myofascial pain syndrome (MPS). Patients and methods: Between March 2018 and September 2018, a total of 94 patients (16 males, 78 females; mean age 44.2±11.94 years; range, 19 to 74 years) with the diagnosis of MPS were included in the study. The patients were divided into two groups. The treatment group consisted of 49 patients and a total of seven sessions of high-energy flux density ESWT (H-ESWT) (0.26 mJ/mm2) were given with three days interval. The control group consisted of 45 patients and the treatment of hot pack, transcutaneous electrical nerve stimulation, and ultrasound was given for five days for two weeks. At baseline and one month after treatment, the visual analog scale (VAS), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Neck Disability Index (NDI), and Beck Depression Inventory (BDI) scores were compared between the groups. Results: There were no statistically significant differences in the age, sex, demographic characteristics, and baseline VAS, SF-36, NDI, BDI, FACIT, and PSQI scores between the groups (p>0.05). In the ESWT group, there was a statistically significant decrease in the VAS, SF-36, NDI, BDI, FACIT, and PSQI scores after treatment compared to the baseline scores, while only the SF-36 subscale scores were statistically significantly higher (p


1. Simons DG, Travell J. Myofascial trigger points, a possible explanation. Pain 1981;10:106-9.

2. Novikova LB, Akopyan AP. Myofascial pain syndrome. Zh Nevrol Psikhiatr Im S S Korsakova 2015;115:21-4. [Abstract]

3. Sciotti VM, Mittak VL, DiMarco L, Ford LM, Plezbert J, Santipadri E, et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain 2001;93:259-66.

4. Wade SW, Strader C, Fitzpatrick LA, Anthony MS. Sex- and age-specific incidence of non-traumatic fractures in selected industrialized countries. Arch Osteoporos 2012;7:219-27.

5. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain 1987;30:115-26.

6. Simons DG, Travell JG, Simons LS, editors. Myofascial pain and dysfunction: upper half of body. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 1999.

7. Sabatke S, Scola RH, Paiva ES, Kowacs PA. Injecction of trigger points in the temporal muscles of patients with miofascial syndrome. Arq Neuropsiquiatr 2015;73:861-6.

8. Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil 2002;83:40-7.

9. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol 2007;21:427-45.

10. De las Penas CF, Campo MS, Carnero JF, Miangolarra Page JC. Manual therapies in myofascial trigger point treatment: A systematic review. J Bodyw Mov Ther 2005;9:27-34.

11. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. Int J Osteopath Med 2006;9:120-36.

12. Simons DG. Myofascial pain and dysfunction syndrome. J Muscoskel Pain 1993;1:123-32.

13. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009;13:3-10.

14. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am 2007;91:229-39.

15. van der Windt DA, van der Heijden GJ, van den Berg SG, ter Riet G, de Winter AF, Bouter LM. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 1999;81:257-71.

16. Pan PJ, Chou CL, Chiou HJ, Ma HL, Lee HC, Chan RC. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phys Med Rehabil 2003;84:988-93.

17. Perlick L, Schiffmann R, Kraft CN, Wallny T, Diedrich O. Extracorporal shock wave treatment of the achilles tendinitis: Experimental and preliminary clinical results. Z Orthop Ihre Grenzgeb 2002;140:275-80. [Abstract]

18. Ordahan B, Türko¤lu G, Karahan AY, Akkurt HE. Extracorporeal shockwave therapy versus kinesiology taping in the management of plantar fasciitis: a randomized clinical trial. Arch Rheumatol 2017;32:227-33.

19. Rompe JD, Rumler F, Hopf C, Nafe B, Heine J. Extracorporal shock wave therapy for calcifying tendinitis of the shoulder. Clin Orthop Relat Res 1995;321:196-201.

20. Gleitz M. Trigger shockwave therapy with radial and focused shockwaves. Current Status Orthop 2006;5:303-12.

21. Gür A, Koca ‹, Karagüllü H, Altında¤ Ö, Madenci E, Tuto¤lu A, et al. Comparision of the effectiveness of two different extracorporeal shockwave therapy regimens in the treatment of patients with myofascial pain syndrome. Arch Rheumatol 2014;29:186-93.

22. Jeon JH, Jung YJ, Lee JY, Choi JS, Mun JH, Park WY, et al. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Ann Rehabil Med 2012;36:665-74.

23. Ji HM, Kim HJ, Han SJ. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius. Ann Rehabil Med 2012;36:675-80.

24. Ramon S, Gleitz M, Hernandez L, Romero LD. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. Int J Surg 2015;24:201-6.

25. Ottomann C, Hartmann B, Tyler J, Maier H, Thiele R, Schaden W, et al. Prospective randomized trial of accelerated re-epithelization of skin graft donor sites using extracorporeal shock wave therapy. J Am Coll Surg 2010;211:361-7.

26. Rompe JD, Hope C, Küllmer K, Heine J, Bürger R. Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow. J Bone Joint Surg [Br] 1996;78:233-7.

27. Travell JG, Simons DG, editors. Myofascial pain and dysfunction. The trigger point manual. Baltimore: Williams and Wilkins; 1992.28. Gallagher EJ, Liebman M, Bijur PE. Prospective validity of clinically important changes in pain severity measured on visual analog scale. Ann Emerg Med 2001;38:633-8.

28. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 2001;38:633-8.

29. Aktürk S, Kaya A, Çetinta D, Akgöl G, Gülkesen A, Kal GA, et al. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study. J Phys Ther Sci 2018;30:448-53.

30. Koçyi¤it H, Aydemir Ö, Fiek G, Ölmez N, Memi A. Reliability and validity of the Turkish Version of Short Form-36. ‹laç ve Tedavisi Dergisi 1999;2:12.

31. A¤argün MY, Kara H, Anlar Ö. The Validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Phschiatry 1996;7:2.

32. Çinar D, Yava A. Validity and reliability of functional assessment of chronic illness treatment-fatigue scale in Turkish patients with type 2 diabetes. Endocrinol Diabetes Nutr 2018;65:409-17.

33. Aslan E, Karaduman A, Yakut Y, Aras B, Simsek IE, Yaglı N. The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976) 2008;33:362-5.

34. Sahin NH. Use of the Beck Depression Inventory with Turkish University Students: Reliability, validity and Factor Analysis. Turkish Journal of Psychology 1989;7:3-13.

35. Ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Arch Phys Med Rehabil 2011;92:657-62.

36. Gonçalves MC, Teixeira da Silva EG, Chaves TC, Dach F, Speciali JG. Static ultrasound and manual therapy in refractory migraine. Case report Rev Dor Sao Paulo 2012;13:80-4.

37. Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol 2009;56:418-24.

38. Hausdorf J, Lemmens MA, Heck KD, Grolms N, Korr H, Kertschanska S, et al. Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system. Neuroscience 2008;155:138-44.

39. Hausdorf J, Lemmens MA, Kaplan S, Marangoz C, Milz S, Odaci E, et al. Extracorporeal shock wave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5. Brain Res 2008;1207:96-101.

40. Dündar Ü, Solak Ö, amli F, Kavuncu V. Effectiveness of ultrasound therapy in cervical myofascial pain syndrome: a double blind, placebo-controlled study. Arch Rheumatol 2010;25:110-15.

41. Srbely JZ, Dickey JP, Lowerison M, Edwards AM, Nolet PS, Wong LL. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008;139:260-6.

42. Aguilera FJ, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther 2009;32:515-20.

43. Ay S, Do¤an SK, Evcik D, Baer OC. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int 2011;31:1203-8.

44. Ilter L, Dilek B, Batmaz I, Ulu MA, Sariyildiz MA, Nas K, et al. Efficacy of Pulsed and Continuous Therapeutic Ultrasound in Myofascial Pain Syndrome: A Randomized Controlled Study. Am J Phys Med Rehabil 2015;94:547-54.

45. Kavadar G, Ça¤lar N, Özen , Tütün , Demircio¤lu D. Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study. Agri 2015;27:190-6.

46. Yildirim MA, Öne K, Gökeno¤lu G. Effectiveness of ultrasound therapy on myofascial pain syndrome of the upper trapezius: randomized, single-blind, placebocontrolled study. Arch Rheumatol 2018;33:418-23.

47. Azatcam G, Atalay NS, Akkaya N, Sahin F, Aksoy S, Zincir O, et al. Comparison of effectiveness of transcutaneous electrical nerve stimulation and kinesio taping added to exercises in patients with myofascial pain syndrome. J Back Musculoskelet Rehabil 2017;30:291-8.

48. Dissanayaka TD, Pallegama RW, Suraweera HJ, Johnson MI, Kariyawasam AP. Comparison of the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy on the upper trapezius in myofascial pain syndrome: a randomized controlled study. Am J Phys Med Rehabil 2016;95:663-72.

49. Takla MKN. Low-frequency high-intensity versus medium-frequency low-intensity combined therapy in the management of active myofascial trigger points: A randomized controlled trial. Physiother Res Int 2018;23:e1737.

50. Rompe JD, Furia J, Weil L, Maffulli N. Shock wave therapy for chronic plantar fasciopathy. Br Med Bull 2007;81:183-208.

51. Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg 2007;46:348-57.

52. Liang HW, Wang TG, Chen WS, Hou SM. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy. Clin Orthop Relat Res 2007;460:219-25.

53. Chow IH, Cheing GL. Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain. Clin Rehabil 2007;21:131-41.

54. Thiel M. Application of shock waves in medicine. Clin Orthop Relat Res 2001;387:18-21.

55. Cho YS, Park SJ, Jang SH, Choi YC, Lee JH, Kim JS. Effects of combined treatment of extracorporeal shock wave therapy (ESWT) and stabilisation exercises on pain and functions of patients with myofascial pain syndrome. J Phys Ther Sci 2012;24:1319-23.

56. Müller-Ehrenberg H, Licht G. Diagnosis and therapy of myofascial pain syndrome with focused shock waves (ESWT) Med Orthop Tech 2005;5:1-6.

57. Hong JO, Park JS, Jeon DG, Yoon WH, Park JH. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum. Ann Rehabil Med 2017;41:582-8.

58. Park KD, Lee WY, Park MH, Ahn JK, Park Y. Highversus low-energy extracorporeal shock-wave therapy for myofascial pain syndrome of upper trapezius: A prospective randomized single blinded pilot study. Medicine (Baltimore) 2018;97:e11432.

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