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Background ‘Shock wave’ therapies are now extensively used in the treatment of musculoskeletal injuries. This systematic review summarises the evidence base for the use of these modalities.
Methods A thorough search of the literature was performed to identify studies of adequate quality to assess the evidence base for shockwave therapies on pain in specific soft tissue injuries. Both focused extracorporeal shockwave therapy (F-ESWT) and radial pulse therapy (RPT) were examined.
Results 23 appropriate studies were identified. There is evidence for the benefit of F-ESWT and of RPT in a number of soft tissue musculoskeletal conditions, and evidence that both treatment modalities are safe. There is evidence that F-ESWT is effective in the treatment of plantar fasciitis, calcific tendinitis, and that RPT is effective in plantar fasciitis. Where benefit is seen in F-ESWT, it appears to be dose dependent, with greater success seen with higher dose regimes. There is low level evidence for lack of benefit of low-dose F-ESWT and RPT in non-calcific rotator cuff disease and mixed evidence in lateral epicondylitis.
Patients with burn injuries persistently experience severe pain exacerbated by therapeutic procedures during rehabilitation therapy and the re-epithelization process, which includes aseptic dressing and skin grafting,  unlike patients with skeletal muscular injuries whose pain for the treatment duration gradually subsides as they recover from morbidity, although it can progress to chronic pain. The absence of sufficient pain modulation during the treatment period for the burn injury can lead to poor compliance with physical or occupational therapy, an increased frequency of progression to chronic pain, paresthesia that persists for over a year,  and the persistence of depressive symptoms because of post-traumatic stress disorder (the prevalence rates vary between 8% and 45%).  Approximately 70% to 80% of burn patients complain of paresthetic sensation and ∼35% complain of pain in the scar tissue that lasts for more than a year.[ 4 5] Therefore, pain modulation during the rehabilitation therapy period should be just as dynamic as it was in the initial wound treatment stage following burn injury. 
Pain in burn patients during rehabilitation therapy is caused by a combination of direct stimulation of the skin and subcutaneous tissues that were subjected to thermal and mechanical injuries from the burn. Burn injuries over joint areas, especially in the extremities, are complicated by joint contracture as a result of long periods of immobilization for wound treatment; thus, pain modulation is very important in enabling physical therapy or occupational therapy to prevent joint contracture, and medications such as opioids, nonsteroidal anti-inflammatory drugs, and anti-psychotic drugs are presently widely used for pain modulation.  However, because pharmacological treatments can cause side effects and complications such as drug addiction, nonpharmacological treatments such as transcutaneous electrical nerve stimulation, burn rehabilitation massage therapy,  and virtual reality rehabilitation system  are being combined in a useful manner.  Although various treatments such as medication  and the aforementioned adjuvant therapies are effective in pain modulation for burn scars during rehabilitation therapy, many burn patients still complain of pain that is not being modulated.  Therefore, the need for new and more effective treatments for pain modulation of burn scars has emerged.