Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial
One page on PainSci cites Alsulaimani 2024: Does Ultrasound or Shockwave Therapy Work?
PainSci commentary on Alsulaimani 2024: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
More shockwave data…more negativity! We didn’t much need another thumbs-down trial of this, but we got it anyway: radial shockwave versus sham in 76 people over 3 months, measuring primarily VISA-A scores
Result? “No evidence for between-group differences” at any time, for any outcome. 😕
There are some minor caveats for this trial:
- The dosage might be a bit dodgy. Maybe more shocking waves would have worked better.
- Some missing masking. The providers shouldn't know who got the sham. It’s probably not a serious error in this case, but nevertheless a classic science foul.
- And the sham had a touch too much potential to actually treat via the same mechanism as shockwave itself: causing discomfort, conditioned pain modulation, but in my opinion that’s quite unlikely. See Counterstimulation, Counterirritation, and Gate Control.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVES: To investigate the efficacy of adding radial extracorporeal shockwave therapy or sham to exercise for people with insertional Achilles tendinopathy. DESIGN: A two-armed, parallel-group, explanatory, single-centre, randomised controlled trial within a superiority framework. SETTING: Private clinic. PARTICIPANTS: People diagnosed with insertional Achilles tendinopathy who were over 18 years old with a symptom duration of greater than 3 months. INTERVENTION: A total of 76 people were randomly assigned (one-to-one ratio) to receive three sessions of radial extracorporeal shockwave therapy or sham to the affected side (or most affected side if bilateral). All participants received identical education and exercise. OUTCOME MEASURES: The primary outcome was the Victorian Institute of Sports Assessment - Achilles questionnaire. Measures were recorded at baseline, 6 weeks and 12 weeks. RESULTS: At 12 weeks, the questionnaire data were available for 37 people (96%) in the radial extracorporeal shockwave therapy group and 36 people (95%) in the sham group. For the primary outcome, we found no evidence for between-group differences at 6 (3, 95% confidence interval -4.6-10.5) or 12 weeks (4.6, 95% confidence interval -2.5-11.6). There was also no evidence for a between-group difference for any secondary outcome measures at either 6 or 12 weeks (p > .05). No serious adverse events were reported. CONCLUSION: The addition of radial extracorporeal shockwave therapy to exercise and education did not lead to improvements in pain, function or other outcomes compared to sham at 6 or 12 weeks among people with insertional Achilles tendinopathy.ANZCTR Reg No: ACTRN12620000035921.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.