Sanzo P. et al., 2024: Shockwave therapy and fibromyalgia and its effect on pain, blood markers, imaging, and participant experience - a multidisciplinary randomized controlled trial.

Tuesday, 04 June 2024

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Sanzo P, Agostino M, Fidler W, Lawrence-Dewar J, Pearson E, Zerpa C, Niccoli S, Lees SJ.
Faculty of Health and the Behavioral Sciences, Kinesiology Department, Lakehead University, Thunder Bay, Canada.
Medical Sciences, NOSM University - Thunder Bay Campus, Thunder Bay, Canada.

Abstract

Background: Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results.

Objectives: To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively.

Methods: Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group.

Results: There were no statistically significant differences in the BSS for hypermobility (p = .21; d = .74), PCS (p = .70; d = .22), VAS (p = .17-.61; d = .20-.83) scores, QST for skin temperature and stimuli (p = .14-.65; d = .25-.88), and for the pressure pain threshold (p = .71-.93; d = .05-.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals.

Conclusion: RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity.

Physiother Theory Pract. 2024 Feb 21:1-16. doi: 10.1080/09593985.2024.2321503. Online ahead of print. PMID: 38384123

Comments 1

Jens Rassweiler on Tuesday, 04 June 2024 11:00

Despite the number of treatment options for fibromyalgia (FMI available, interventions remain largely ineffective. In light of its demonstrated effectiveness, safety, and ease of use in previous studies for the treatment of failed tendon healing responses and myofascial pain syndromes, shockwave therapy has the potential to be useful as a pain modulator in the FM population.
This pilot study investigates the impact of radial shockwave therapy (RWST) on fibromyalgia patients, focusing on pain reduction, changes in blood markers, imaging results, and participant experiences. Shockwave therapy is a non-invasive treatment that uses acoustic waves to stimulate healing and reduce pain.
In this randomized controlled trial, 15 participants with fibromyalgia were divided into two groups: one receiving shockwave therapy and the other receiving a placebo treatment. Various measures were taken before and after the treatment period to assess pain levels, blood markers associated with inflammation, imaging results, and participant-reported experiences.
The RSWT group received five treatments over a five-week period, targeting the three most painful areas, while the placebo group received sham treatment.

Results showed no significant differences in hypermobility, pain catastrophizing, pain intensity, sensory testing, or pressure pain thresholds between the groups. However, clinically significant improvements in pain scores were observed in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys indicated pain and symptom improvements, providing hope to participants. Overall, RSWT was found to be safe and acted as a pain modulator in reducing sensitivity in fibromyalgia patients.

This article discusses the efficacy and effects of Radial Extracorporeal Shock Wave Therapy (RSWT) compared to a placebo on various measures for patients with fibromyalgia (FM). The study aimed to assess pain levels, pain catastrophizing, function, attention, depression, and other psychological indices. Additionally, it sought to identify differences in cytokine concentrations between FM participants and healthy controls (HCs) and evaluate the impact of RSWT on peripheral blood mononuclear cell (PBMC) function.
The findings indicated no statistically significant difference in hypermobility or pain catastrophizing between the treatment and placebo groups. However, there was a trend towards reduced pain catastrophizing in the treatment group. While there wasn't a significant difference in pain levels between the groups, the treatment group showed a trend towards reduction in pain intensity compared to the placebo group.
The study also explored responses to various sensory stimuli, such as heat, cold, light touch, vibration, and deep pressure, finding significant differences in response between the treatment and placebo groups, suggesting that RSWT may modulate sensitivity to these stimuli.
Regarding cytokine release from PBMCs, there were no significant differences between FM participants and HCs, nor between the treatment and placebo groups pre- and post-intervention. However, a positive correlation was observed between IL-6 and IL-10 delta effective change ratios.
While neuroimaging did not show significant changes in cortical thickness following the intervention, participant feedback indicated overall positive views of the treatment.
In conclusion, RSWT appears to be safe and may act as a pain modulator for FM patients, reducing sensitivity to chronic widespread pain and pain catastrophizing. It has to be mentioned, that both cohorts were very small. Thus, further research with larger sample sizes is needed to confirm its effectiveness and identify responsive subgroups within the FM population

Jens Rassweiler

Results showed no significant differences in hypermobility, pain catastrophizing, pain intensity, sensory testing, or pressure pain thresholds between the groups. However, clinically significant improvements in pain scores were observed in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys indicated pain and symptom improvements, providing hope to participants. Overall, RSWT was found to be safe and acted as a pain modulator in reducing sensitivity in fibromyalgia patients.

This article discusses the efficacy and effects of Radial Extracorporeal Shock Wave Therapy (RSWT) compared to a placebo on various measures for patients with fibromyalgia (FM). The study aimed to assess pain levels, pain catastrophizing, function, attention, depression, and other psychological indices. Additionally, it sought to identify differences in cytokine concentrations between FM participants and healthy controls (HCs) and evaluate the impact of RSWT on peripheral blood mononuclear cell (PBMC) function.
The findings indicated no statistically significant difference in hypermobility or pain catastrophizing between the treatment and placebo groups. However, there was a trend towards reduced pain catastrophizing in the treatment group. While there wasn't a significant difference in pain levels between the groups, the treatment group showed a trend towards reduction in pain intensity compared to the placebo group.
The study also explored responses to various sensory stimuli, such as heat, cold, light touch, vibration, and deep pressure, finding significant differences in response between the treatment and placebo groups, suggesting that RSWT may modulate sensitivity to these stimuli.
Regarding cytokine release from PBMCs, there were no significant differences between FM participants and HCs, nor between the treatment and placebo groups pre- and post-intervention. However, a positive correlation was observed between IL-6 and IL-10 delta effective change ratios.
While neuroimaging did not show significant changes in cortical thickness following the intervention, participant feedback indicated overall positive views of the treatment.
In conclusion, RSWT appears to be safe and may act as a pain modulator for FM patients, reducing sensitivity to chronic widespread pain and pain catastrophizing. It has to be mentioned, that both cohorts were very small. Thus, further research with larger sample sizes is needed to confirm its effectiveness and identify responsive subgroups within the FM population

Jens Rassweiler

Despite the number of treatment options for fibromyalgia (FMI available, interventions remain largely ineffective. In light of its demonstrated effectiveness, safety, and ease of use in previous studies for the treatment of failed tendon healing responses and myofascial pain syndromes, shockwave therapy has the potential to be useful as a pain modulator in the FM population. This pilot study investigates the impact of radial shockwave therapy (RWST) on fibromyalgia patients, focusing on pain reduction, changes in blood markers, imaging results, and participant experiences. Shockwave therapy is a non-invasive treatment that uses acoustic waves to stimulate healing and reduce pain. In this randomized controlled trial, 15 participants with fibromyalgia were divided into two groups: one receiving shockwave therapy and the other receiving a placebo treatment. Various measures were taken before and after the treatment period to assess pain levels, blood markers associated with inflammation, imaging results, and participant-reported experiences. The RSWT group received five treatments over a five-week period, targeting the three most painful areas, while the placebo group received sham treatment. Results showed no significant differences in hypermobility, pain catastrophizing, pain intensity, sensory testing, or pressure pain thresholds between the groups. However, clinically significant improvements in pain scores were observed in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys indicated pain and symptom improvements, providing hope to participants. Overall, RSWT was found to be safe and acted as a pain modulator in reducing sensitivity in fibromyalgia patients. This article discusses the efficacy and effects of Radial Extracorporeal Shock Wave Therapy (RSWT) compared to a placebo on various measures for patients with fibromyalgia (FM). The study aimed to assess pain levels, pain catastrophizing, function, attention, depression, and other psychological indices. Additionally, it sought to identify differences in cytokine concentrations between FM participants and healthy controls (HCs) and evaluate the impact of RSWT on peripheral blood mononuclear cell (PBMC) function. The findings indicated no statistically significant difference in hypermobility or pain catastrophizing between the treatment and placebo groups. However, there was a trend towards reduced pain catastrophizing in the treatment group. While there wasn't a significant difference in pain levels between the groups, the treatment group showed a trend towards reduction in pain intensity compared to the placebo group. The study also explored responses to various sensory stimuli, such as heat, cold, light touch, vibration, and deep pressure, finding significant differences in response between the treatment and placebo groups, suggesting that RSWT may modulate sensitivity to these stimuli. Regarding cytokine release from PBMCs, there were no significant differences between FM participants and HCs, nor between the treatment and placebo groups pre- and post-intervention. However, a positive correlation was observed between IL-6 and IL-10 delta effective change ratios. While neuroimaging did not show significant changes in cortical thickness following the intervention, participant feedback indicated overall positive views of the treatment. In conclusion, RSWT appears to be safe and may act as a pain modulator for FM patients, reducing sensitivity to chronic widespread pain and pain catastrophizing. It has to be mentioned, that both cohorts were very small. Thus, further research with larger sample sizes is needed to confirm its effectiveness and identify responsive subgroups within the FM population Jens Rassweiler

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