Extracorporeal Shockwave Therapy in Pain Management - an In-Depth Narrative Review

The purpose of this narrative review is to explain the cellular mechanisms behind chronic pain, the mechanisms behind extracorporeal shockwave therapy, and its efficacy for the treatment of various chronic pain conditions including tendinopathies, greater trochanteric pain, de quervain tenosynovitis, myofascial pain, plantar fasciitis, fibromyalgia, osteoarthritis, fractures, osteonecrosis, bone edema, coccydynia, low back pain, chronic pelvic pain syndrome/chronic prostatitis, ulcers, and carpal tunnel syndrome.

Many recent clinical trials and meta-analyses from the year 2024 overall supported the efficacy of extracorporeal shockwave therapy for the treatment of chronic pain conditions with minimal adverse effects.

Extracorporeal shockwave therapy is a novel technique that uses mechanotransduction to induce a cellular response that prevents central sensitization, reduces inflammation, and contributes to healing that alleviates pain. The specific mechanisms through which extracorporeal shockwave therapy are largely unknown or poorly understood. A literature search of Scopus, PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted to identify 84 studies from 2000-2024 evaluating the efficacy of extracorporeal shockwave therapy for the treatment of chronic pain conditions. The results indicate that extracorporeal shockwave therapy holds strong promise for the treatment of numerous chronic pain pathologies with minimal adverse effects and should be studied further.