The clinical utility of extracorporeal shock wave therapy for burn pruritus: A prospective, randomized, single-blind study

Abstract

Purposes: To investigate the effect and mechanisms of extracorporeal shock wave therapy (ESWT) on burn scar pruritus.

Methods: Forty-six patients participated (experimental group, n=23; sham stimulation group, n=23). Patients had complaints of severe pruritus ranging from 5 to 10 on the visual analog scale. The experimental group received 1000-2000 shock waves for each treatment with 100 impulses/cm², each with low-energy flux density (0.05-0.20mJ/mm²) and a 1-week interval between treatments for 3 weeks. The numerical rating scale (NRS), 5D-Itch Scale, and Leuven Itch Scale were evaluated immediately before ESWT and after the third session. Laser Doppler blood perfusion imaging (LDI) was performed immediately before ESWT and after the first and third sessions.

Results: In the experimental group, mean NRS scores were 6.30±1.29 before therapy and 3.57±2.09 after the third session, and the difference was significant (p<0.001). NRS scores in the experimental group after the third ESWT were significantly decreased compared to those of the sham stimulation group (p=0.009). The duration, severity, and consequences scores of pruritus on the Leuven Itch Scale after the third ESWT were significantly decreased in the experimental group compared with the sham stimulation group (p=0.033, p=0.007, and p=0.009, respectively). The direction score on the 5-D Itch Scale after the third ESWT was significantly decreased in the experimental group compared to the sham stimulation group (p=0.033). After the first ESWT session and after 3 sessions, the burn area had a significant increase in perfusion according to LDI, compared with the scores before treatment in the experimental group (p=0.023 and p=0.013, respectively).

Conclusion: ESWT is a non-invasive modality that significantly reduced burn-associated pruritus.

Keywords: Burn; ESWT; Extracorporeal shock wave therapy; Pruritus.