What is Shockwave Therapy and can it reduce the pain of CRPS?

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Shockwave therapy? A lady suffering CRPS emailed to ask whether I knew anything about it. I had to confess that I didn’t. My first thought was that, whatever it is, it doesn’t sound very pleasant; not the type of therapy where you’re watching the clock keenly until the next session. In fact, before investigating it further, I was expecting to find quackery of the worst kind; but much to my surprise, no. There is published mainstream research on this therapy, including one paper on CRPS.

What is shockwave therapy?

Shockwave therapy is the use of targeted, high amplitude waves of energy similar to sound waves for a variety of medical purposes. The therapy has been around for a long time and was first used in the treatment of kidney and gallbladder stones. In this context, shockwaves are used to fragment the stones, with the fragments then passing naturally out of the body.

Over time, variations on the therapy have been found to be beneficial in other spheres, particularly in orthopaedics and rehabilitation, where it is used to treat a growing number of conditions affecting joints, tendons and muscles. Research has shown that it can also prove helpful for chronic pain. A 2014 studysuggests that shockwave therapy in conjunction with an exercise programme can be beneficial for those suffering chronic low back pain.

Whilst not entirely clear, the principle behind the therapy may have something to do with increasing blood flow to the affected area, thereby accelerating the body’s own healing process.

Can it reduce the pain of CRPS?

In 2010, a paper was published detailing the results of research “to assess the efficacy of shockwave therapy in the management of complex regional pain syndrome.” This was a small scale study involving only 30 patients. As the results of the study were likely to be more reliable if the therapy was focused on the same area of the body in each participant, the researchers chose people affected by CRPS of the medial femoral condyle. This is one of the two projections at the base of the femur – so essentially part of the knee. However, it is not clear whether the selection criteria additionally distinguished between CRPS I and CRPS II and/or the acute and chronic phases of the condition.

Each participant underwent 3 sessions of treatment, each at 72 hour intervals. The results were reported as follows:

Satisfactory results were observed in 76.7% of the cases (23 patients) at the 2-month follow-up visit, and in 80% (24 patients) at the 6-month follow-up visit. The therapeutic effects of [shockwave therapy] were caused by decreasing pain. The significant improvements we obtained bear witness to the potential value of [shockwave therapy] therapy in the management of CRPS.

For a non-invasive and essentially safe treatment that seems very impressive. So impressive in fact that you might expect that by now larger scale trials would have been undertaken. But it seems not. No further research seems to have been published on the benefits (or otherwise) of shockwave therapy for CRPS. Clearly, without positive results from larger scale research, this treatment is unlikely ever to migrate to the mainstream treatment arsenal.

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