Effects of Extracoporeal Shock Wave Therapy (rESWT) on Chronic Nonspecific Low Back Pain

Nonspecific Low Back Pain (nsLBP) is the bane of human and has a lifetime prevalence of 70%. New treatments are welcome though results are confusing.

Guo X, Li L, Yan Z, et al. Efficacy and safety of treating chronic nonspecific low back pain with radial extracorporeal shock wave therapy (rESWT), rESWT combined with celecoxib and eperisone (C + E) or C + E alone: a prospective, randomized trial.
J Orthop Surg Res. 2021;16(1):705.
doi:10.1186/s13018-021-02848-x
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642949/

• “Patients in the rESWT group received rESWT using the Swiss DolorClast device (Electro Medical Systems, Nyon, Switzerland) and the EvoBlue handpiece. Each patient received four rESWT sessions (one session per week). Each session consisted of a total of 4000 radial extracorporeal shock waves (rESWs) (1000 rESWs each applied to the left and the right paravertebrate muscles from the third lumbar segment (L3) to the first sacral segment (S1) using the 36-mm applicator, plus 1000 rESWs each applied to the left and the right sacroiliacal joint using the 15-mm convex applicator, in prone position of the patient). The air pressure of the rESWT device (and, thus, the energy flux density (EFD) of the applied rESWs) was gradually increased during the first 200 rESWs each until the maximum discomfort the patient could tolerate was reached, followed by 800 rESWs at this air pressure/EFD. The rESWs were applied at a frequency of 15 rESWs/second.”
• eperisone (3 × 50 mg per day) – a muscle relaxant
• “celecoxib (1 × 200 mg (mg) per day for moderate pain (Numerical Rating Scale (NRS) score 4–6) or 2 × 200 mg per day” – that last dose is big!
• “All patients were advised to perform simplified, safe core stability training and flexion/relaxation training at home, which was mainly based on the contraction of the lumbar muscles, under the guidance of a unified rehabilitation training video (two training sessions per week; each training session lasting for approximately 20 min; training for the entire duration of the study).”

Results on Pain Levels:

• Shock wave alone was better than meds and home care measures but shock wave with meds was no better than meds – they conceptualized that painkilling measures interfered with rESWT effects but that sounds odd.
• Have to wait for further studies