Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study.

The study included only 60 patients, with 20 in each group, and the authors said larger groups are needed. The paper did not state a primary outcome, so the main result depends on which secondary measures are emphasized. All patients received an exercise program, so the separate contribution of shock wave therapy, sham shock wave therapy, or ultrasound cannot be isolated. Sham shock wave therapy was used, but no sham ultrasound control was described, so the ultrasound group was not compared with an identical placebo. The paper did not report dropouts or how missing data were handled. Follow-up timing is described inconsistently: methods say evaluation four weeks after treatment, while results discuss 6 weeks after treatment. Participants had pain for at least 6 months and no recent treatment, injections, or surgery, so results may not apply to acute or recently treated patients.

The authors declared no conflict of interest. The paper does not state who funded the study.

Do not conclude that shock wave therapy is better than ultrasound. The study found no significant difference between shock wave therapy and ultrasound on any parameter. Do not conclude the machine alone caused improvement, because all patients also received an exercise program.