Ryskalin Larisa, Morucci Gabriele, Natale Gianfranco, Soldani Paola, Gesi Marco
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy.
Life (Basel). 2022 May 17;12(5):743. doi: 10.3390/life12050743.
In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.
近年来，体外冲击波疗法（ESWT）因其对各种骨骼和软组织病变的潜在有益作用而受到越来越多的关注，在缓解疼痛和功能恢复方面取得了令人鼓舞的成果。事实上，ESWT已成为一种用于治疗多种肌肉骨骼疾病（包括肌筋膜疼痛综合征（MPS））的替代、非侵入性且安全的治疗方法。特别是，MPS是一种常见的慢性疼痛病症，在受肌肉骨骼问题影响的患者中占比最大。值得注意的是，筋膜系统的感觉神经支配和伤害感受器正逐渐成为MPS中疼痛产生的关键因素。与此同时，越来越多的证据表明，ESWT的应用会导致感觉无髓神经纤维的选择性丧失，从而产生持久的镇痛效果。本综述中讨论的研究结果旨在提供新的观点，可能会进一步丰富我们对深筋膜疾病之间复杂相互作用的认识，这些相互作用包括神经支配的变化、筋膜伤害感受器的敏化、MPS慢性肌肉骨骼疼痛的病理生理学以及ESWT诱导的镇痛作用。此外，深入了解ESWT减轻疼痛作用的分子机制，可能会将冲击波临床实践的领域扩展到远远超出肌肉骨骼系统或其最初用于碎石术的应用范围。
