Effectiveness of ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis

Abstract

Objective

The objective of this review was to assess the therapeutic effect of ultrasound (US) on myofascial pain syndrome (MPS).

Date sources

PubMed, Embase, and Cochrane Library were searched to find relevant studies from January 1966 to May 2016 using keywords. Four investigators performed the data extraction.

Study selection

Randomized controlled trials (RCTs) investigating the outcomes of pain and physical function between MPS patients receiving and not receiving US were selected by two researchers independently.

Data extraction

Data were extracted from the RCTs. Risk of bias and study quality were evaluated following the recommendations of Cochrane Collaboration. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated.

Data synthesis

A total of 10 studies involving 428 MPS patients were included. US therapy significantly reduced pain intensity (SMD [CI]=−1.41 [−2.15, −0.67], P=0.0002) and increased pain threshold (SMD [CI]=1.08 [0.55, 1.60], P<0.0001), but had no significant effect on cervical range of motion (ROM) of lateral flexion (SMD [CI]=0.40 [−0.19, 0.99], P=0.19), rotation (SMD [CI]=0.10 [−0.33, 0.52], P=0.66), or extension or flexion (SMD [CI]=0.16 [−0.35, 0.68], P=0.53). Heterogeneity between studies was mainly attributed to differences in the follow-up time, parameter of US, course of treatment, and the control group. The overall risk of bias from the included studies was high, and the evidence proving these effect calculations were assessed as low quality.

Conclusion

Owing to the high risk of bias and the across-trial heterogeneity of the studies, the current evidence is not clear enough to support US as an effective method to treat MPS. Clinical trials with methodological rigorousness and adequate power are needed to confirm it in the future.

Keywords:

• ultrasound
• myofascial pain syndrome
• meta-analysis

Supplementary material

Search strategies for PubMed, Embase and the Cochrane Library database

PubMed

1. Myofascial Pain Syndromes [Mesh]

2. Myofascial Pain Syndrome [Title/Abstract]

3. Pain Syndrome, Myofascial [Title/Abstract]

4. Pain Syndromes, Myofascial [Title/Abstract]

5. Syndrome, Myofascial Pain [Title/Abstract]

6. Syndromes, Myofascial Pain [Title/Abstract]

7. Myofascial Trigger Point Pain [Title/Abstract]

8. Trigger Point Pain, Myofascial [Title/Abstract]

9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9

10. ultrasound [Title/Abstract]

11. 10 and 11

Embase

1. “myofascial pain”/exp

2. “pain syndrome, myofascial”:ab,ti

3. “pain syndromes, myofascial”:ab,ti

4. “syndrome, myofascial pain”:ab,ti

5. “syndromes, myofascial”:ab,ti

6. “myofascial trigger point pain”:ab,ti

7. “trigger point pain, myofascial”:ab,ti

8. 1 or 2 or 3 or 4 or 5 or 6 or 7

9. “ultrasound”:ab,ti

10. 8 and 9

Cochrane Library

1. MeSH descriptor: [Myofascial Pain Syndromes] explode all trees

2. Myofascial Pain Syndrome:ti,ab,kw or Pain Syndrome, Myofascial:ti,ab,kw or Pain Syndromes, Myofascial:ti,ab,kw or Syndrome, Myofascial Pain:ti,ab,kw or Syndromes, Myo-fascial Pain:ti,ab,kw (Word variations have been searched)

3. Myofascial Trigger Point Pain:ti,ab,kw or Trigger Point Pain, Myofascial:ti,ab,kw (Word variations have been searched)

4. ultrasound:ti,ab,kw (Word variations have been searched)

5. 1 and 2 and 3 and 4

Acknowledgments

We thank the Nanjing Medical Science and Technology Development Program (YKK15085) for financial support.

Disclosure

The authors report no conflicts of interest in this work.