Extracorporeal shock-wave therapy for heel pain: results are unimpressive

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Extracorporeal shock-wave therapy for heel pain: results are

" unimpressive "

Rheumawire

Jun 22, 2004 Zosia Chustecka

Berlin, Germany - Extracorporeal shock-wave therapy (ESWT) for heel pain

(plantar fasciitis) has produced " unimpressive results, " concludes a

meta-analysis of clinical trials presented at the recent EULAR meeting

[1]. However, a placebo-controlled trial with a new ESWT device also

presented at the meeting was described as " excellent " [2].

ESWT has become increasingly popular in recent years in the treatment of

various musculoskeletal injuries, including tennis elbow, Achilles

tendonitis, and plantar heel pain. However, clinical trials of this

therapy have had divergent results and the evidence for its

effectiveness is unclear, comment Dr CE and colleagues from the

orthopedics department of the Edinburgh Royal Infirmary, Scotland.

In particular, 2 large placebo-controlled trials of this therapy in

plantar fasciitis that have recently been published both came out

negative, as reported by rheumawire. The results led to calls for no

further trials to be conducted in this condition, the researchers note,

and so they conducted a systematic review and meta-analysis of existing

trials.

They found 10 trials, including the 2 recent negative ones, involving a

total of 1179 patients. The trials evaluated different doses of ESWT

against either a placebo dose or a control dose so low as to be

considered clinically ineffective. However, only 5 of the trials,

involving 683 patients, permitted a pooled estimate of effectiveness on

morning pain. The data failed to demonstrate a statistically significant

improvement in morning pain at an average of 3 months between the active

treatment and the placebo/control groups, the researchers report.

The pooled outcomes from 683 patients included in this review were

" certainly unimpressive, " and these data do not recommend the use of

ESWT in the treatment of heel pain, they concluded.

However, proponents of shock-wave therapy have pointed out that there

are several different devices in use, each of which uses a different

technology to produces shock waves. These shock waves differ in their

physical parameters, and so they may also differ in efficacy, they

suggest.

At the EULAR meeting, a neighboring poster presentation detailed results

from a placebo-controlled study of a new device, the OrthospecTM system

(Genesis Medical Systems, London, UK), which uses hydroelectric

technology to deliver a high-energy shock wave, without any need for

x-ray or ultrasound guiding. Dr J Bloch and colleagues (University

Hospital, Strasbourg, France) treated 54 patients. At 8 weeks, there was

a significant difference between the treated and placebo patients in

painful symptoms (measured on a visual analog scale for pain and for

walking distance), but not for quality of life. At 28 weeks, these " good

results were maintained or had improved, " they reported in the poster,

with a significant difference between the 2 groups seen in all 3

measures. " The long-term results confirm the efficacy on pain, walking

distance, and quality of life and place ESWT first in the nonaggressive

strategy of treatment for chronic plantar fasciitis, " they conclude.

Sources

Thomson CE, Crawford F. The effectiveness of

extracorporeal shock-wave therapy for plantar heel pain: a systematic

review and meta-analysis. Presented at: EULAR 2004; Berlin, Germany;

June 9-12, 2004. Abstract SAT0373

Bloch J, Kieffer D, Velten M, et al. Extracorporeal

shock-wave therapy (ESWT) for chronic plantar fasciitis with or without

heel spur: preliminary short-term results of a randomized double-blind,

placebo-controlled trial. Presented at: EULAR 2004; Berlin, Germany;

June 9-12, 2004. Abstract SAT0367.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org