A multimodal approach is most often necessary to adequately manage chronic nonspecific neck pain and low back pain (LBP). The treatment plan may include medications with differing sites of action, physiotherapy, psychosocial interventions, minimally invasive interventional techniques, and in some cases, surgery. Unfortunately, many of these options are not without risk. For instance, long-term use of NSAIDs is associated with cardiovascular, renal, and gastrointestinal adverse effects, and opioid analgesics come with the risk of tolerance, dependence, and addiction. Therapeutic ultrasound is a commonly utilized noninvasive modality that has shown effectiveness in the management of common musculoskeletal disorders, including myofascial pain syndrome, pelvic pain, and knee osteoarthritis. However, its effectiveness in LBP and neck pain has not been confirmed.
For a systematic review published in Pain Medicine, my colleagues and I sought to evaluate whether monotherapy with continuous ultrasound provides better pain control than standard therapy or no therapy in adults with chronic nonspecific neck pain and LBP. The therapeutic effects of ultrasound are mainly derived from thermal and nonthermal effects as mechanical ultrasound energy is absorbed by tissues, enhancing tissue healing and repair. We identified and reviewed 10 randomized control trials that evaluated therapeutic ultrasound in chronic LBP and neck pain.
The overall findings suggest that ultrasound is more effective than placebo. Three studies focusing on chronic neck pain found significant relief when ultrasound was combined with other treatments. However, only one of the studies demonstrated that ultrasound was the cause of improvement. A significant benefit of ultrasound therapy is its excellent safety profile and ease of use, which is ideal given that many of the options in our current armamentarium are associated with side effect profiles that are often intolerable or preclude their use in patients with contraindications.
Due to a lack of well-designed trials, the effectiveness of therapeutic ultrasound was not determined and there is insufficient evidence to recommend its routine use in the treatment of these conditions. While reasonable evidence indicates that low-intensity ultrasound therapy in conjunction with exercise treatments may improve pain scores immediately after treatment for chronic LBP, evidence of long-term benefits is lacking. In both pain syndromes, blinded trials with adequate follow-up are needed to define the true effect of ultrasound therapy.