體外震波治療於下背痛之應用

Extracorporeal Shockwave Treatment of Low Back Pain

近年來針對體外震波（extracorporeal shock wave therapy, ESWT）在肌肉骨骼疾病的應用有如雨後春筍般增加，無論是網球肘、足底筋膜退化、旋轉肌腱鈣化等都有越來越多的研究和實際應用，雖然目前對於體外震波的作用機制仍有許多未知之處，但在針對下背痛的體外震波應用方面，我們可分為以下幾個可能的治療方向來思考：（1）針對軟組織損傷的修復：體外震波有助於增加細胞膜通透性、增加微血管血循、刺激纖維母細胞、降低肌肉張力和緩解肌肉緊繃，由此打破肌筋膜疼痛症候群中因肌肉縮短導致局部組織缺氧的惡性循環。（2）針對疼痛的神經調控：體外震波被證實除了有助於神經去敏感化外、也可能選擇性地破壞無髓鞘神經纖維、降低Substance P濃度等，綜合以上結果而產生止痛的效果。（3）作為其他治療的輔助角色：體外震波因其非侵入性和無放射線暴露的好處，可以搭配其他的治療等形成更全面完整的治療計畫。綜合上述，善用體外震波治療，我們可提供下背痛病人更有效完善的治療方式。 Extracorporeal Shockwave Treatment (ESWT) is widely used in musculoskeletal disorder treatment nowadays. There is an increasing number of studies on ESWT of lateral epicondylopathy, plantar fasciopathy, or calcific rotator cuff tendinopathy. Based on the clinical evidence from the literature, three possible ways to implement ESWT are proposed when treating low back pain patients. (1) Soft tissue injury repair: ESWT has various benefits like increased vascularity, stimulate fibroblast growth, lower muscle tone and spasticity, and thus helps to improve energy crisis status in myofascial pain syndrome. (2) Neuromodulation of pain: ESWT is proved helpful in desensitization, selectively destructing non-myelinated nerve fibers and lowering the substance P level. (3) Enhancement of treatment efficiency on combination with other modalities: ESWT is non-invasive and carried out without radiation exposure. Therefore, the combined use of ESTW with other treatments provides an excellent approach.