Narrative review: Extracorporeal shock wave therapy for pain management in musculoskeletal rehabilitation: Mechanisms, clinical applications, and safety

This narrative review synthesizes current evidence on extracorporeal shock wave therapy for pain management in musculoskeletal rehabilitation, emphasizing its analgesic mechanisms, clinical applications, and safety. As a noninvasive physical therapy, extracorporeal shock wave therapy is increasingly used for pain relief in conditions such as chronic low back pain, plantar fasciopathy, knee osteoarthritis, rotator cuff injury, and myofascial pain syndrome. Its analgesic effects arise through multiple pathways, including peripheral neuroregulation characterized by degeneration and subsequent regeneration of sensory nerve fibers, reduction of pro-inflammatory mediators, improved local blood flow, and, according to emerging functional magnetic resonance imaging data, modulation of central pain networks. Evidence from randomized controlled trials and meta-analyses supports the efficacy of extracorporeal shock wave therapy in reducing pain intensity and improving function across these disorders. The safety profile of extracorporeal shock wave therapy is favorable, with most adverse events being mild and transient local reactions. Nonetheless, standardized treatment parameters are lacking, and data on vulnerable populations remain sparse. This review aims to serve as a scientific reference for extracorporeal shock wave therapy in musculoskeletal pain management and to identify priorities for future research.