Comparison of the effectiveness of classic physical therapy agents and extracorporeal shock wave therapy (ESWT) on pain, disability, functional state and depression in patients with chronic low back pain: Prospective randomized controlled study

Introduction and purpose: Low back pain; is a complaint that every individual in society can encounter at a high rate of 84% in a period of his/her life. Chronic low back pain is defined as lasting more than 12 weeks of low back pain. Chronic low back pain is a serious cause of disability in society.In chronic low back pain pharmacological agents, therapeutic exercises, physical therapy agents, local interventional therapies, surgical treatments and combinations of these treatments are used as treatment modalities. Recently, studies showing that ESWT is effective in the treatment of Chronic low back pain have been published. This study was planned as a randomized controlled trial to compare the clinical efficacy of classic physical therapy agents (TENS +hot pack + ultrasound) and rESWT in the treatment of Chronic low back pain. Materials and Methods:. Male and female patients aged between 18 and 65 years with low back pain and chronic low back pain for at least 3 months were included. Ninety-one patients were randomized into two groups in a closed envelope procedure. TENS, hot pack and ultrasound were given to 44 patients in the classical physical therapy group. 47 patients in the Extracorporeal Shock Wave Therapy (ESWT) group were given ESWT treatment for a total of 5 sessions 2-3 weeks at least 2 days apart. All patients received exercise therapy. Two patients in the ESWT group did not continue treatment because of pain after the first session. 19 patients in both groups did not come to the 3rd month controls. Evaluations were repeated before treatment, after treatment and at 3 months. Beck Depression Scale was used to determine the level of depression and Oswestry Disability Index (ODI) and Health Assessment Questionnaire (HAQ) were used to determine the degree of disability. The Visual Pain Scale (VAS) was used to question the pain in individuals and pressure-pain threshold was measured using an Algometer. Results: Both groups were statistically similar in terms of age, gender, educational background, body mass index and disease duration. There was no statistically significant difference between pretreatment VAS scores, HAQ total scores, Oswetry scores, pain threshold levels and Beck Depression Scores. Although the VAS scores decreased in both groups after treatment, the decrease was higher in the ESWT group. Similarly, post-treatment oswetry scores were significantly lower in both groups compared to pretreatment, whereas the decrease was higher in the ESWT group. It was observed that the pain threshold levels did not change in the electrotherapy group after the treatment, but there was a significant increase in the ESWT group for each point. Similarly, there was a significant difference between the scores obtained from the Beck Depression Scale before and after treatment in the ESWT group Conclusion: ESWT was found to be a superior treatment option for electrotherapy in terms of pain level, functional status, depression symptoms and pain threshold in low back pain. Although the groups showed similar characteristics at the first visit, the superior effect of ESWT treatment was achieved by both self-reported measures, clinical tests and objective criteria. In this respect, the benefits of ESWT in clinical practice should be assessed. Clinical studies on ESWT are very limited. We think that the clinical findings we obtained from the study make a significant contribution to the literature on ESWT. Further studies with larger patient groups are needed to confirm the findings presented in the study. Keywords: Chronic low back pain, ESWT, TENS, ultrasound, physical therapy agents