Efficacy of Extracorporeal Shock Wave Therapy (ESWT) on Cervical Myofascial Pain Following Neck Dissection Surgery
Phase: NA
Conditions: Pain, Cervical Pain
Sponsor: Qassim University

Efficacy of Extracorporeal Shock Wave Therapy On Cervical Myofascial Pain Following 
Neck Dissection Surgery 
12-2-2020 
Study Protocol 
Objective: Cervical myofascial pain is one of the problems that contribute in chronic neck pain 
following neck dissection surgery, so we aimed to investigate efficacy of extracorporeal shock 
wave therapy (ESWT) on cervical myofascial pain in expression of decreasing pain and improving 
cervical range of motion (ROM).  
 
Design: This trial is a single blind randomized control experimental study. 
 
Subjects: 46 patients with cervical myofascial pain following neck dissection surgery were 
recruited in this trial and subdivided at random into two equal groups. ESWT Group: received 
ESWT once a week for 4 weeks (0.25 ml/mm2, 1000 shocks) plus topical none steroidal anti-
inflammatory drug (NSAID; 3 times /day for 4 weeks). Control Group: received only topical 
NSAID.  
 
Outcome measures: Pain assessment was measured by visual analogue scale (VAS) and pressure 
algometry. Cervical range of motion device (CROM) was used for assessment of lateral flexion 
and rotation of neck ROM for both sides. All measurements were collected before the beginning 
of the study, after 2 weeks and at the trial termination (after 4 weeks). 
 
 

Results: ESWT Group revealed significant improvement in all parameters at post I and II 
compared to control group (p > 0.001), while the control group revealed only a statistical decrease 
in VAS at post I without any statistical difference in pain threshold and neck ROM, however, there 
were statistical differences in all parameters at post II compared to pre-treatment and post I (p < 
0.001).  
 
 
Conclusion: Higher statistical results were achieved with ESWT without any side effects 
confirming the safety and efficiency of ESWT in cervical myofascial pain.  
 
 
 
 
 
Subject characteristics:  
The mean ± SD of subjects’ characteristics of both groups is illustrated in Table 1. There weren't 
statistical differences (p>0.05) in the mean of age, weight, height and sex distribution between 
groups. 
  
 Effect of treatment on rotation and side bending ROM, VAS and PTT:  
Mixed MANOVA showed a significant interaction effect of treatment and time (Wilks’ Lambda 
= 0.01, F (12, 30) = 227.55, p = 0.001, = 0.98). There was a significant main effect of time (Wilks’ 
Lambda = 0.005, F (12, 30) = 489.27, p = 0.001, = 0.99). There was a significant main effect of 
treatment (Wilks’ Lambda = 0.03, F (6, 36) = 162.55, p = 0.001, = 0.96). Table 2 and 3 showed 
descriptive statistics of rotation and side bending ROM, VAS and PTT and the statistical level of 

comparison between groups as well as significant level of comparison between pre, post I and post 
II in each group.  
  
 Between group comparisons 
Pre-trial evaluations revealed non statistical difference between both study and control groups in 
all measured variables (p > 0.05). A significant increment of neck rotation, and side bending ROM 
in both directions away and toward the operated side with a marked improvement of PPT was 
reported at post I and II in the study group compared to control group (p > 0.001). Moreover, there 
was a significant decrease in VAS of the study group at post I and at post II compared to control 
group (p > 0.001). 
 
 Within group comparison 
Statistical improvements were reported in the rotation and side bending ROM in both directions 
away and toward the operated side and also in PPT in the study group at post II in comparison with 
pre-treatment and post I (p < 0.001); furthermore, a significant amelioration in the rotation and 
side bending ROM in both directions and PPT at post I compared with that pre-treatment (p < 
0.001).There was a statistical diminution of VAS in the study group at post II compared to pre-
treatment and post I (p < 0.001); and also, in VAS at post I in comparison with pre-treatment (p < 
0.001).  
  
There was no statistical difference in the rotation and side bending ROM in both directions and in 
PPT between pre-treatment and post I (p > 0.05) in the control group; However there was a 
statistical increase in the rotation and side bending ROM in both directions and also in PPT at post 
II in comparison with pre-treatment and post I (p < 0.001). There was a statistical decrease in VAS 
in the control group at post II compared with that at pre-treatment and post I (p < 0.001); as well 
in VAS at post I in comparison with pre-treatment (p < 0.001).