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Medical shockwaves for chronic low back pain: a case series.

Kenneth Craig1, Bradley Takai2, Jacqueline Craig3, Sarah Pelham3* Danielle MacDonald3**

1Director Kompass OrthoShock Center for Medical Shockwave Therapy & Research. Auckland, New

Zealand, 2Lead Physiotherapist Kompass Health Associates, Auckland, New Zealand,

3Motion

Analyst Assistant & Health Services Specialist (BHSc., PGDip Psychology, MSc. Student), 3*

Research

Assistant (BHSc. Physiotherapy), 3**

Research Assistant (BHSc., MSc.Kinesiology, PhD. Student

Human Kinesiology), Kompass MotionLab, Auckland, New Zealand.

Introduction

Chronic low back pain which may be either specific or non-specific in nature is a

common yet enigmatic major global public health issue arising from multiple

aetiologies.1 - 4 Since the first low back pain (LBP) guideline (Quebec Task Force,

1987), much research has been dedicated to this disease and there are now over

2000 control trials evaluating treatments for LBP in the Cochrane data base alone.

European, Australian and New Zealand guidelines for the management of LBP are

consistent recommending primarily paracetamol followed by NSAID’s.1 – 6 However

consensus for use of opioids, benzodiazepines, muscle relaxants, surgical

intervention and physical manipulation remain considerably varied.1 – 6 The issue

remains that chronic LBP is often indocile to most interventions and functional

capacity often remains limited even when symptomatic relief may be obtained.7

Therefore, disease modifying interventions rather than symptomatic management

alone require investigation.

Aim

To determine if medical shockwaves may be a potential disease modifying modality

for the treatment of chronic LBP, and to encourage further investigation of

shockwaves in this area.

Methods

Ten patients of varying gender, occupation and age were seen in our clinic. All

patients underwent initial screening utilising: subjective pain scale (VAS), Oswestry

Disability Index (ODI)8,9 and dorsaVi-Move quantitative analysis at baseline, wk 3

and wk12. Medical shockwaves were propagated by an electrohydraulic generator

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(MediSpec Ltd.) over three (3) sessions at one (1) week intervals, were a total of

1000 impulses at 0.12mj/mm² per session were focused bilaterally over the erector

spine region ranging from the mid sacrum to L1. All forms of analgesia and pain

medications were ceased two day prior to treatment and remained discontinued

when possible for the entire treatment and follow-up period. Exercise prescription

were commenced at wk6 and only after satisfactory symptomatic relieve, to help

provide improved motion and regional integrity.

Result

Eight of the nine patients showed excellent improvement with one having marginal

improvement and requires further management. The overall improvement (n=6) were

recorded as follows: VAS (mean baseline 6.7/10; mean post ESWT0.5/10), ODI

(mean baseline 55% - severe disability; mean post ESWT 14% - minimal disability)

and dorsaVi-Move assessment recorded improvements and correction in the

respective individual motion and postural areas of extension, flexion and posture

from baseline in each individual. Dependence on analgesics and pain medication

was changed from daily dependence (n=10) to completely independent (n=7), and

infrequent (n=2).

Discussion & Conclusion

Chronic low back pain is a multifactorial phenomenon that prolongs physical

disability interrupting quality of life and productivity. Medical shockwaves have over

the past decades demonstrated safety and efficacy across medical disciplines by

what is considered as the homeostatic regulation of the neurophysiological,

biochemical and biocellular components of the human organism.10 - 19 This case

series reports positive outcomes in both symptomatic relief and functional restoration

in majority of the cases supporting the premise for further investigation to be carried

out in this area.

Keywords: chronic low back pain, disease modifying, non-pharmacogenic,

systemically neutral, extracorporeal shockwave therapy.

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