Pain management: non-pharmacologic approaches

Extracorporeal Shock Wave Therapy (ESWT)

Scientists believe that ESWT works by direct stimulation of healing, neovascularisation, direct suppressive effects on nociceptors and an hyperstimulation mechanism, that would block the gate-control mechanism. Recent studies have demonstrated that SW treatment can increase the number of neovessels at the normal tendon–bone junction, through the release of growth factors TGFb1 and IGF-I and some other immune substances.


  • Wang CJ, Huang HY, Pai CH. Shock wave enhances neovascularization at the tendon–bone junction. J Foot Ankle Surg. 2002;41:16–22.
  • Wang CJ, Wang FS, Yang KD, Huang CS, Hsu CC, Yang LC. Shock wave therapy induced neovascularization at the tendon–bone junction. A study in rabbits. J Orthop Res. 2003;21:984–989. 

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