Radial Shock Wave and Acupuncture for Myofascial Pain
Condition: Myofascial Pain
MeSH terms: Myofascial Pain Syndromes
Study type: Interventional

Summary: 
      Myofascial pain syndrome is common in Rehabilitation clinic. The pain occurs asymmetrically
      in isolated or regional muscles, and is associated with acute muscle strain or chronic muscle
      overuse. Myofascial pain is characteristics with localized muscle tenderness, palpable
      intramuscular taut band, typical referred pain, and local twitch response.

      Treatment of myofascial pain syndrome includes physical therapy, stretch exercise, dry needle
      insertion and trigger point injection. Acupuncture originated from ancient Chinese medicine
      which involves the insertion of fine needle to stimulate specific points of the body along
      the 12 meridians. The mechanism of pain relief may be initiated by activation of both spinal
      segmental and supraspinal centers. Acupuncture is commonly used for pain relief.

      Recently, radial shock wave has been shown to be effective in the treatment of chronic
      musculoskeletal pain, including calcific tendinitis, epicondylitis, and plantar fasciitis.
      The energy and pressure produced by radial shock wave is focused on the treated
      musculoskeletal tissue. The mechanism of action has been hypothesized that the energy could
      result in analgesic effect and stimulation of angiogenesis and healing response and then
      relief of the symptoms. The effectiveness of radial shock wave on treatment of myofascial
      pain was reported by Jeon and colleagues in 2012.

      The aim of this study is to compare the efficacy of acupuncture and radial shock wave therapy
      in patients with myofascial pain syndrome.
    

Detailed description: 
      80 participants diagnosed with myofascial pain syndrome in trapezius muscle will be enrolled
      from the outpatient clinic of Department of Physical Medicine and Rehabilitation in Shin Kong
      Wu Ho-Su Memorial Hospital .

      The patients will be randomized to either treatment groups: group 1, radial extracorporeal
      shock wave therapy (RSWT group) and group 2, acupuncture group (AC group).

      All treatments will be given in the Department of Physical Medicine and Rehabilitation, and
      will be handled by a physiatrist who is familiar with both kinds of therapy.

      The RSWT is delivered at 2 Hz with 2000 shock waves and the energy level of 0.056 mJ / mm2 in
      the trapezius muscle. Treatment point is the origin attachment of upper trapezius at the
      external occipital protuberance. RSWT will be performed once per week, and will be continued
      for 3 weeks.

      Acupuncture is performed at Fenfchi (GB20) point over upper back. This acupoint is a common
      local point for treating upper back pain. Acupuncture therapy will be provided by the same
      physiatrist to all patients.

      The primary outcome measures are VAS for pain and pain threshold. The secondary outcome
      measures are neck disability index, and patients' satisfaction. All subjects will be assessed
      by an independent, blinded investigator at baseline, post treatment and at 1-month after the
      treatments are completed.

      Demographic data, including age, sex, employment status, and sleep quality, history of head
      or neck surgery, or other psychiatric and medical disorders will be recorded at baseline. A
      history will be taken concerning the duration of complaints (months), previous treatments
      (injections, physical therapy), and current pain medications. Concomitant diseases and the
      use of medications will be registered.
    

Intervention name(s): Radial shock wave; Acupuncture
Intervention type(s): Device; Device
Intervention description(s): radial shock wave: Treatment point is the origin attachment of upper trapezius at the external occipital protuberance. Radial shock wave therapy will be performed once per week, and will be continued for 3 weeks. Acetaminophen will be prescribed as rescue medication, and the amount given will be recorded at the end of the study.; Acupuncture is performed at Fenfchi (GB20) point over upper back by the same physiatrist to all patients.
Other intervention name(s): Dolorclast
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Radial shock wave; Acupuncture