Comparison Of the effectiveness of ESWT andultrasound treatments in myofascial pain syndrome: Plasebo controlled study

Primary target of Myofascial pain syndrome (MPS) treatment is inactivation of trigger points and relaxation of taut bands and various treatment methods are being used for this purpose. The aim of this study is to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and ultrasound (US) in MPS. 60 patients (40 female, 20 male) ranging from 18-60 years of age with the diagnosis of MPS in our clinic were included to the study. Patients were randomised to ESWT, sham ESWT and US treatment groups of 20 persons. ESWT treatment with 1.6-3.0 bar, 200-400 beats/trigger points, maximum 3 minutes/session, frequency 15-21 Hz a total of four sessions and no more 3 days between sessions was applied to the first group (Group 1) and sham ESWT with 1.0-1.3 bar, without beats 3 minutes/session a total of four sessions was applied to the second group (group 2). A total of 10 sessions, 5 minutes for each region at a dose of 1,5 W/cm2 active continuous US was applied to the third group (group 3). All of the patients were evaluated at second and sixth weeks before treatment (BT) and after treatment (AT). Pressure pain threshold measurement (PPT) was made by algometer ,pain score measurement (PS) was made by digital palpation and subjective complaint of pain measurement was made by visual analog scale(VAS). Measurement of disability was evaluated by Nottingham Health Profile (NHP) and SF-36, symptoms of anxiety and depression were evaluated by hospital anxiety and depression scale (HAD) . In group 1 a significant improvement was found in VAS,PPT,PS,NHP-pain and SF-36 sub-parameters after treatment (p<0.016). While there was no significant improvement in any parameters in group 2 after treatment, a significant improvement was obtained in VAS, PPT, PS and NHP-pain parameters in group 3 (p<0.016). Percentage changes of PPT, PS, VAS, SF-36 physical functioning, body pain and vitality sub-headings, NHP-pain parameters after treatment were significantly different between group 1 and 2 (p<0.016). After treatment the percentage changes of VAS, PPT, PS and NHP-pain parameters were significantly different between group 2 and 3 (p<0.016). No side effects were observed in all patients. We think that ESWT-a new therapeutic approach is an effective and safe treatment in MPS. Key words: Myoafascial pain syndrome, ultrasound, extracorporeal shock wave therapy.