Effect of Extracorporeal Shockwave Therapy on Pain Management of Patients with Post-Stroke Hemiplegic Shoulder Pain: A Prospective Randomized Controlled Trial

Post-stroke hemiplegic shoulder pain (HSP) is a common complication leading to significant activity limitation. Some approaches have been recommended for the management of HSP, and most of them have various adverse effects, while none were established to be effective. This study aimed to evaluate the effect of minimally invasive extracorporeal shockwave therapy (ESWT) on patients with HSP pain management.Using a single-blind, randomized clinical trial, 43 patients with HSP were randomly assigned to complete three focus ESWT sessions once a week and additional five radial ESWT sessions twice a week. Patients in the control arm received zero energy ESWT. Visual analog scale, passive range of motion (ROM), Fugl-Meyer upper extremity assessment (FMA-UE), and shoulder pain and disability scale (SPADI) were measured at baseline, at the end of the interventions, and within four and eight weeks' intervals to evaluate the pain, function, and ROM in the affected shoulder.Both groups showed an improvement in pain scores on the fourth and eighth weeks visits (P-value <0.001). Intervention with ESWT could effectively lead to a less severe pain score compared to the control group (P-value <0.001). In the intervention group, the ROM improved in both passive abduction and forward flexion (P-value <0.05), but no significant change was observed in the control group (P-value >0.05). FMA-UE and SPADI did not differ significantly between groups.Based on the findings of this study, the combination of rESWT and focused ESWT can efficiently improve stroke-induced HSP.