THE EFFECTIVENESS OF RADIAL SHOCKWAVE THERAPY IN THE PAIN MANAGEMENT OF PATIENTS WITH LATERAL EPICONDYLITIS: A SYSTEMATIC REVIEW

Abstract

Background: Lateral epicondylitis (LE) is a common and often chronic elbow pain condition with a high prevalence among the working-age population, which poses a social and economic burden worldwide. The most prominent symptom of LE is pain, resulting in emerging research focusing on pain control methods that use extracorporeal shockwave therapy (ESWT), as recommended by national guidelines. The literature, however, is ambiguous regarding the different types of ESWT and their efficacy. Systematic reviews (SR) have previously been conducted on ESWT with LE, but none have been focused on rESWT alone. The SR aims to collate all the available English language evidence regarding the effect of rESWT in terms of pain management for patients with LE.

Methodology: A comprehensive search of the Medline, PEDro, EMBASE, Scopus, CINAHL and AMED databases between 7th – 30th October 2022 yielded seven randomised controlled trials (RCTs) suitable for inclusion. Two independent reviewers critically appraised the included studies using the PEDro scale, and five RCTs were forwarded for data extraction. Due to the clinical heterogeneity of the studies, narrative synthesis was performed.

Results: Five good-quality RCTs with a total of 273 participants were reviewed. The included RCTs demonstrated statistically significant pain reduction among LE patients pre- and post-rESWT in the short- and intermediate-term (<3 months and ≤6 months follow-up) (p<0.001). However, not all studies agreed that rESWT was superior to sham rESWT or other conventional methods for LE pain management. The findings showed that rESWT was superior to local corticosteroid injection (LCI) (12-week follow-up) and prolotherapy (8-week follow-up) and when rESWT is combined with stretching exercise and massage therapy is superior to sham rESWT with the same exercises and massage (24-week follow-up) (p<0.001). Meanwhile, rESWT had an insignificant statistical effect in comparison to sham rESWT alone (12-week follow-up) and to exercise therapy and platelet-rich plasma (PRP) with exercise (24-week follow-up) (p>0.05).

Conclusion: There is inconsistent evidence regarding the efficacy of relying on rESWT for pain management among LE patients. Although rESWT appears to be safe because no adverse effects were reported in the included studies, which might indicate the clinical significance effect of the rESWT, some evidence suggests that rESWT is no better than sham rESWT, exercise therapy or PRP with exercise. However, other evidence suggests using rESWT instead of injection therapy (LCI and prolotherapy) and a combined stretch exercise, massage and rESWT approach is effective for controlling LE pain. Due to the limited quantity and quality of the included RCTs, further, higher-quality RCTs are required to clarify the efficacy of rESWT for pain management among LE patients.