A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part I: Effects on pain

ABSTRACT

Introduction: Neurogenic heterotopic ossification (NHO) is a complication of a neurological injury following traumatic brain injury (TBI) and may be present around major synovial joints. It is often accompanied by severe pain, which may lead to limitation in activities of daily living. Currently, a common intervention for NHO is surgery, which has been reported to carry many additional risks. This study was designed to assess the effect of extracorporeal shock wave therapy (ESWT) on pain in patients with TBI with chronic NHO.

Methods: A series of single-case studies (n = 11) was undertaken with patients who had TBI and chronic NHO at the hip or knee. Each patient received four applications of high-energy EWST delivered to the affected joint over 8 weeks. Two-weekly follow-up assessments were carried out, and final assessments were made 3 and 6 months post-intervention. Pain was measured using the Faces Rating Scale, and X-rays were taken at baseline and 6-months post-intervention to physiologically measure the size of the NHO.

Results: The application of high-energy ESWT was associated with significant overall reduction of pain in patients with TBI and NHO (Tau-0.412, 95% confidence interval −0.672 to −0.159, p = 0.002).

Conclusions: ESWT is a novel non-invasive intervention for reducing pain resulting from NHO in patients with TBI.

Supplemental materials

Supplemental data can be accessed on the publisher’s website.

Acknowledgments

The authors would like to thank Medispec for their generosity in lending Minispec™ machine for the duration of the trial; the staff of the X-ray department of Lowenstein Hospital Rehabilitation Centre for their support in this trial; Miss Sharon Ross for her invaluable assistance in setting up the trial; and the patients themselves and their families.

Declaration of interest

The authors report no conflicts of interest.