P-20 Comparison between treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy

Abstract

Background Lateral epicondylitis is one of the most common overuse injuries, which has been reported to reduce function and affect daily activities. There is no standard therapy for lateral epicondylitis. In Hong Kong, the use of acupuncture and extracorporeal shockwave therapy (ESWT) has been popular in treating lateral epicondylitis in recent years. Objective This study is to compare the treatment effects of acupuncture and ESWT on lateral epicondylitis. Methods In this study, we evaluated 34 patients (34 elbows) with lateral epicondylitis. Seventeen patients were treated by 3-week ESWT, one session per week. Another seventeen were treated by 3-week acupuncture therapy, two sessions per week. The outcome measure included pain score by visual analogue scale (VAS), maximal grip strength by Jamar dynamometer and level of functional impairment by Disability of arms, shoulders and hands questionnaire (DASH). Subjects were assessed in three time points: baseline, after treatment (after all prescribed sessions) and 2-week follow-up. Results Two treatments showed no significant difference at all assessment time-point. For the longitudinal comparison, VAS showed significant difference in both acupuncture and ESWT group between baseline and after treatment. Also, it showed significant difference in both acupuncture and ESWT group between baseline and at 2-week follow-up. For maximal grip strength and DASH score, both outcome measures showed no significant difference in both acupuncture and ESWT group either between baseline and after treatment or between baseline and 2-week follow-up. While both groups showed no significant difference between after treatment and at 2-week follow-up. Conclusions The treatment effects of acupuncture and ESWT on lateral epicondylitis were similar. The pain relief persisted for at least two weeks after treatment. This resembled the results of two systematic reviews (1-2) which showed the short-term pain relief effect of acupuncture on lateral epicondylitis. No significant change of pain in 2-week follow-up implied pain relief effect persisted for at least 2 weeks. However, the improvement in maximal grip strength and DASH score was not significant after treatment. In a previous study, it was found that pain relief effect of one session of acupuncture therapy would diminish within around 20 hours (3). Therefore, any pain relief effect longer than this duration may imply more complicated mechanism of pain relief such as modulation of signal pathways. Therefore, we suggest that studies in the future should include outcome assessment immediately after each session. Adverse effect of ESWT has been reported by systematic reviews (4,5) while there was no data regarding adverse effect following acupuncture. In our study, 17.6% patients from the acupuncture group reported soreness after treatment; 29.4% patients from the ESWT group complained of pain. This indicated that acupuncture might be a better option for treating lateral epicondylitis with similar treatment effect. One of the limitations in this study was no follow-up for long-term effect. The follow-up was only up to 2 weeks after treatment. Another limitation is that there was no control group in this study. These limitations were attributed to the general practice in our clinics. Acknowledgment This study is supported by the MSc & PgD in Sports Medicine and Health Science, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong References Trinh KV, Phillips SD, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: A systematic review. Rheumatology (Oxford). 2004;43(9):1085–1090. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39(7):411–22; discussion 411-22. Molsberger A, Hille E. The analgesic effect of acupuncture in chronic tennis elbow pain. Br J Rheumatol. 1994;33(12):1162–1165. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39(7):411–22; discussion 411-22. Buchbinder R, Green SE, Youd JM, Assendelft WJ, Barnsley L, Smidt N. Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain. J Rheumatol. 2006;33(7):1351–1363.