Effectiveness and safety of extracorporeal shock wave treatment for low back pain:a systematic review and meta-analysis of RCTs

2020 ◽  
Author(s):  
Jinhui Ma ◽  
Yan Yan ◽  
Bailiang Wang ◽  
Wei Sun ◽  
Debo Yue ◽  
...  
Keyword(s):  
Shock Wave ◽  
Rating Scale ◽  
Meta Analysis ◽  
Post Treatment ◽  
Mean Difference ◽  
Control Group ◽  
Low Back ◽  
China National Knowledge Infrastructure ◽  
Pain Scores ◽  
Extracorporeal Shock Wave

Abstract Background Extracorporeal shock wave therapy (ESWT) has been widely used in musculoskeletal disorders. This meta-analysis was designed to assess the effectiveness and safety of ESWT for patients with low back pain (LBP). Methods Multiple electronic databases including Pubmed, Embase, Cochrane’s library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December, 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences were calculated for continuous outcomes, while odd ratios were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Results Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P <0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4-6 weeks, the pooled mean difference in ODI scores was −14.10 (P <0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. Conclusions The use of focused ESWT is effective in alleviating pain and improving the general fuctional state for patients with LBP. However, more evidence was needed to verify its safety.

scholarly journals Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090343
Author(s):  
Yifei Fan ◽  
Ziyan Feng ◽  
Jun Cao ◽  
Weili Fu
Keyword(s):  
Shock Wave ◽  
Energy Level ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Extracorporeal Shock Wave Therapy ◽  
Achilles Tendinopathy ◽  
Shock Wave Therapy ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Extracorporeal Shock Wave

Background: Achilles tendinopathy is a frequent sports injury, and extracorporeal shock wave therapy (ESWT) has been proposed as a treatment. Purpose: To compare outcomes between ESWT and other nonsurgical intervention (including sham shock wave therapy) in Achilles tendinopathy patients. Study Design: Systematic review; Level of evidence, 2. Methods: We included 5 randomized controlled trials and 3 case-control studies published between 2005 and 2018. We analyzed pain scores and other outcomes that were reported in more than 3 of the 8 studies. Results: ESWT was associated with significantly better scores than comparison therapy on the visual analog scale for pain ( P < .01), American Orthopaedic Foot & Ankle Society scale ( P = .01), Likert scale for satisfaction ( P = .03), Roles and Maudsley scale ( P < .01), Victorian Institute of Sports Assessment–Achilles questionnaire ( P < .01), and numerical rating scale ( P = .02). The 2 patient groups did not differ significantly in tenderness ( P = .34) or pain threshold ( P = .24). Subgroup analysis showed that ESWT led to better VAS pain scores than comparison treatments at both low-energy level (0.06-0.11 mJ/mm2) and medium-energy level (0.12-0.25 mJ/mm2) and at both shorter (<6 months) and longer (≥6 months) follow-up. Conclusion: ESWT improves pain and functional outcomes in patients with Achilles tendinopathy. Further research is needed to determine the optimal energy level.

scholarly journals 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

2020 ◽  
Author(s):  
Xuejiao Guo ◽  
Lin Li ◽  
Zhe Yan ◽  
Yunze Li ◽  
Zhiyou Peng ◽  
...  
Keyword(s):  
Shock Wave ◽  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Low Back ◽  
Shock Wave Therapy ◽  
Level Of Evidence ◽  
Extracorporeal Shock Wave

AbstractBackgroundTo investigate whether respectively radial extracoporeal shock wave therapy (rESWT) or a combination of rESWT, Celecoxib and Eperisone (rESWT+C+E) are superior in reducing pain in subjects with chronic nonspecific low back pain (cnsLBP) compared to C+E alone (a standard treatment of this condition in China).Methods140 subjects with cnsLBP were randomly allocated to rESWT (n=47), rESWT+C+E (n=45) or C+E alone (n=48) for four weeks. Outcome was evaluated using the Pain Self-Efficacy Questionnaire (PSEQ), Numerical Rating Scale (NRS), Oswestry Low Back Pain Disability Questionnaire and Patient Health Questionnaire 9, collected at one week (W1), W2, W3, W4 and W12 after beginning of the therapy.ResultsAll scores showed a statistically significant improvement over time. The PSEQ and NRS scores showed a significant Time × Treatment effect. Subjects treated with rESWT had significantly lower mean NRS values than subjects treated with rESWT+C+E at W1 and W3, as well as than subjects treated with C+E alone at W3 and W4. No severe adverse events were observed.ConclusionrESWT may be superior to respectively rESWT+C+E or C+E alone in reducing pain in subjects with cnsLBP. Level of Evidence: Level I, prospective, randomized, active-controlled trial.

scholarly journals The Effect of Extracorporeal Shock Wave on Osteonecrosis of Femoral Head: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Jin Mei ◽  
Lili Pang ◽  
Yu Gong ◽  
Zhongchao Jiang
Keyword(s):  
Shock Wave ◽  
Femoral Head ◽  
Meta Analysis ◽  
Core Decompression ◽  
Visual Analogue Score ◽  
Harris Hip Score ◽  
Lesion Area ◽  
China National Knowledge Infrastructure ◽  
Osteonecrosis Of Femoral Head ◽  
Extracorporeal Shock Wave

Abstract Background: This study aimed to determine whether ESWT (extracorporeal shock wave therapy) has an efficient effect on ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes.Method: Two authors independently searched the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database) , Pubmed, Embase and Springer databases. Search period from the inception dates to June 2, 2020 and have no limitations in language; Two authors independently conducted Quality evaluation and data extraction for included studies and preformed a meta-analysis with data extracted and calculated by using review manager 5.3.Result: Nine articles with 409 patients were included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieved higher Harris scores compared to before treatment (MD= -19.95;95% CI: -26.27, -13.64;). The differences were statistically significant (p<0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieved lower VAS compared to baseline (MD= 2.77;95%CI: 1.88, 3.65;), the differences were statistically significant (p<0.01). the pooled results of lesion of MRI with 164 hips show that ESWT decrease the lesion area of MRI (SMD=1.03,CI: 0.75,1.30,),the differences were statistically significant (p<0.01).Conclusion: ESWT have an effect in pain relief and can improve motion function. It's effect better than surgical groups (core decompression and core decompression with bone grafting). But it may not decrease the lesion area of the femoral head on MRI.

scholarly journals 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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xuejiao Guo ◽  
Lin Li ◽  
Zhe Yan ◽  
Yunze Li ◽  
Zhiyou Peng ◽  
...  
Keyword(s):  
Shock Wave ◽  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Controlled Trial ◽  
Low Back ◽  
Shock Wave Therapy ◽  
Level Of Evidence ◽  
Extracorporeal Shock Wave ◽  
Level I

Abstract Background To investigate whether respectively radial extracoporeal shock wave therapy (rESWT) or a combination of rESWT, celecoxib and eperisone (rESWT + C + E) are superior in reducing pain in patients with chronic nonspecific low back pain (cnsLBP) compared to C + E alone (a standard treatment of this condition in China). Methods 140 patients with cnsLBP were randomly allocated to rESWT (n = 47), rESWT + C + E (n = 45) or C + E alone (n = 48) for four weeks between November 2017 and March 2019. Outcome was evaluated using the Pain Self-Efficacy Questionnaire (PSEQ), Numerical Rating Scale (NRS), Oswestry Low Back Pain Disability Questionnaire and Patient Health Questionnaire 9, collected at baseline as well as one week (W1), W2, W3, W4 and W12 after baseline. Results All scores showed a statistically significant improvement over time. The PSEQ and NRS scores showed a significant Time × Treatment effect. Patients treated with rESWT had significantly lower mean NRS values than patients treated with rESWT + C + E at W1 and W3, as well as than patients treated with C + E alone at W3 and W4. No severe adverse events were observed. Conclusions rESWT may not be inferior to respectively rESWT + C + E or C + E alone in reducing pain in patients with cnsLBP. Level of Evidence: Level I, prospective, randomized, active-controlled trial. Trial registration: Clinicaltrials.gov Identifier NCT03337607. Registered November 09, 2017, https://www.clinicaltrials.gov/ct2/show/NCT03337607. Level of evidence Level I; prospective, randomized, controlled trial.

Nerve Block on Pain After Mammaplasty: A Meta-Analysis of randomized controlled studies

2020 ◽  
pp. 229255032096964
Author(s):  
Xiaoxia Li ◽  
Ying Li
Keyword(s):  
Pain Intensity ◽  
Nerve Block ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
Control Group ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Randomized Controlled Studies ◽  
The Impact

Background: Nerve block showed some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis was conducted to investigate the efficacy of nerve block for pain control after mammaplasty. Methods: The databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched for collecting the randomized controlled trials (RCTs) regarding the impact of nerve block on pain intensity after mammaplasty. Results: This meta-analysis included 4 RCTs. Compared with control group after mammaplasty, nerve block resulted in remarkably reduced pain scores at 1 hour (mean difference [MD] = −1.84; 95% CI = −2.49 to −1.20; P < .00001), 3 hours (MD = −1.04; 95% CI = −1.47 to −0.62; P < .00001), 6 hours (MD = −0.96; 95% CI = −1.48 to −0.43; P = .0004), and analgesic consumption (standard mean difference = −1.27; 95% CI = −1.73 to −0.82; P < .00001), but showed no significant impact on pain scores within 24 hours (MD = −0.31; 95% CI = −1.05 to 0.43; P = .41). Conclusions: Nerve block was associated with substantially reduced pain intensity after mammaplasty.

scholarly journals Tolerability of statin-based management of patients with a history of statin-associated muscle symptoms: protocol for a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e052341
Author(s):  
Fanny Villoz ◽  
Christina Lyko ◽  
Cinzia Del Giovane ◽  
Nicolas Rodondi ◽  
Manuel R Blum
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Mean Difference ◽  
Control Group ◽  
Cochrane Central Register ◽  
Eligibility Criteria ◽  
Clinical Issue ◽  
Standard Data ◽  
Evaluation Approach ◽  
History Of

IntroductionStatin-associated muscle symptoms (SAMSs) are a major clinical issue in the primary and secondary prevention of cardiovascular events. Current guidelines advise various approaches mainly based on expert opinion. We will lead a systematic review and meta-analysis to explore the tolerability and acceptability and effectiveness of statin-based therapy management of patients with a history of SAMS. We aim to provide evidence on the tolerability and different strategies of statin-based management of patients with a history of SAMS.Methods and analysisWe will conduct a systematic review of randomised controlled trials (RCTs) and non-randomised studies with a control group. We will search in Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Clinical Trials, Scopus, Clinicaltrials.gov and Proquest from inception until April 2021. Two independent reviewers will carry out the study selection based on eligibility criteria. We will extract data following a standard data collection form. The reviewers will use the Cochrane Collaboration’s tools and Newcastle-Ottawa Scale to appraise the study risk of bias. Our primary outcome will be tolerability and our secondary outcomes will be acceptability and effectiveness. We will conduct a qualitative analysis of all included studies. In addition, if sufficient and homogeneous data are available, we will conduct quantitative analysis. We will synthesise dichotomous data using OR with 95% CI and continuous outcomes by using mean difference or standardised mean difference (with 95% CI). We will determine heterogeneity visually with forest plots and quantitatively with I2 and Q-test. We will summarise the confidence in the quantitative estimate by using Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationAs a systematic review of literature without collection of new clinical data, there will be no requirement for ethical approval. We will disseminate findings through peer-reviewed publications.PROSPERO registration numberCRD42020202619.

scholarly journals Entonox® inhalation to reduce pain in common diagnostic and therapeutic outpatient urological procedures: a review of the evidence

2012 ◽  
Vol 94 (1) ◽  
pp. 8-11 ◽  
Author(s):  
A Young ◽  
M Ismail ◽  
AG Papatsoris ◽  
JM Barua ◽  
JG Calleary ◽  
...  
Keyword(s):  
Shock Wave ◽  
Nitrous Oxide ◽  
Prostate Biopsy ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Control Group ◽  
Day Case ◽  
Flexible Cystoscopy ◽  
Extracorporeal Shock Wave ◽  
Urological Procedures

INTRODUCTION Entonox® (50% nitrous oxide and 50% oxygen; BOC Healthcare, Manchester, UK) is an analgesic and anxiolytic agent that is used to successfully reduce pain and anxiety during dental, paediatric and emergency department procedures. In this article we review the application and efficacy of Entonox® in painful local anaesthesia urological procedures by performing a systematic review of the literature. METHODS A MEDLINE® search was performed using the terms ‘nitrous oxide’, ‘Entonox’, ‘prostate biopsy’, ‘flexible cystoscopy’ and ‘extracorporeal shock wave lithotripsy’. English language publications of randomised studies were identified and reviewed. RESULTS The search yielded five randomised studies that investigated the clinical efficacy of Entonox® as an analgesic for day case urological procedures. Three randomised controlled trials (RCTs) investigated Entonox® in transrectal ultrasonography guided prostate biopsy. All three reported significant reductions in pain score in the Entonox® versus control groups. One RCT reported significant reduction in pain during male flexible cystoscopy in the Entonox® group compared with the control group. One RCT, which examined the use of Entonox® during extracorporeal shock wave lithotripsy, found its use significantly decreased the pain score compared with the control group and this was comparable to intravenous pethidine. CONCLUSIONS Evidence from varied adult and paediatric procedures has shown Entonox® to be an effective, safe and patient acceptable form of analgesia. All published studies of its use in urological day case procedures have found it to significantly reduce procedural pain. There is huge potential to use this cheap, safe, effective analgesic in our current practice.

Cost-Effectiveness Study of the Extracorporeal Shock-Wave Lithotriptor

1990 ◽  
Vol 6 (4) ◽  
pp. 623-632 ◽  
Author(s):  
Evi E. Hatziandreu ◽  
Karen Carlson ◽  
Albert G. Mulley ◽  
Milton C. Weinstein
Keyword(s):  
Shock Wave ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Time Frame ◽  
Upper Urinary Tract ◽  
Extracorporeal Shock Wave ◽  
Probability Estimates ◽  
Urinary Tract Stones ◽  
Ultrasonic Lithotripsy ◽  
Cost Effectiveness Study

AbstractWe performed a cost-effectiveness analysis to examine the relative efficacy and costs of percutaneous ultrasonic lithotripsy (PUL), extracorporeal shock-wave lithotripsy (ESWL), and surgery for the treatment of upper urinary tract stones. We developed a Markov model with 35 states, cycles of 3 months, and a time frame of 5 years. Probability estimates were derived from a meta-analysis of the published literature. For stones less than or equal to 2 cm, ESWL is preferred to PUL, since it prevents 2 additional days of morbidity and saves $440. For larger stones, PUL is preferable to ESWL, avoiding 4 more days of morbidity, and saving $722. Both ESWL and PUL were superior to surgery. Sensitivity analysis showed that the results are sensitive to ESWL efficacy rates, the stone recurrence rate, and the hospital component of the ESWL cost. Our analysis suggests that although ESWL is preferable, relatively small changes in the efficacy and cost can shift the preferred strategy; in addition, these findings underscore the need for more reliable data.

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