Extracorporeal shockwave therapy for pain reduction of musculoskeletal diseases: Predictors and responders

Introduction/Background Musculoskeletal disorders are a continuous challenge for the search for practical and viable treatment solutions that generate analgesia and well-being. Objectives To discover the predictors of the outcome of radial extracorporeal shockwave therapy (rESWT) on pain reduction of patients with musculoskeletal diseases and to identify the best responders of this therapy. Design Short-term retrospective before-after trial. Setting Outpatient facility of a Physical Medicine and Rehabilitation Service. Participants Nine hundred medical records of patients with musculoskeletal disorders (rotator cuff syndrome, De Quervain syndrome, trigger finger, lateral epicondylitis, pseudarthrosis, trochanteric bursitis, anserine syndrome, knee osteochondritisdissecans, patellofemoral syndrome, plantar fasciitis, Achilles tendinitis) who undertook rESWT for pain reduction. Patients younger than 18 years of age, with ongoing treatment at the time of the medical record selection, with other associated diseases, and whose information was unclear or incomplete in the medical records were not included. Intervention Radial extracorporeal shockwave therapy, applied once a week for two weeks. Main outcome measure Pain, assessed before and one week after the end of the intervention is the main outcome and was measured by Visual Analogue Scale (VAS). The participants’ pathology, demographic data and pain at baseline were approached via multiple regression for the predictors and odds ratio for the responders. Results Pain was reduced in 63.4% (VAS = 2.90, 95% CI: 2.72–3.08). Higher levels of pain at baseline, higher frequencies of rESWT application, and knee diseases were the predictors of the treatment outcome (β = −0.21, P  ≤ 0.001, β = −0.88, P  ≤ 0.001, and β = 1.10, P  = 0.001, respectively). Patients with shoulder diseases were the best responders to the rESWT (OR = 1.91, 95% CI: 1.21–3.02). Conclusion There is strong evidence that rESWT is effective for reducing pain of patients with severe pain treated with higher application frequencies. Patients with knee diseases tend benefit less from rESWT, whereas those with shoulder diseases are the best responders this treatment.