Effect of extracorporeal shock wave therapy on intercostobrachial neuralgia post-mastectomy: A randomized controlled trial

Background. Intercostobrachial neuralgia is a neuropathic and chronic pain condition that may develop as a consequence of surgical treatment for breast cancer. It adversely affects physical functioning and the patient’s quality of life. However, treating neuropathic pain with extracorporeal shock wave therapy (ESWT) helps minimize these problems. Purpose. This study aims to investigate the effect of ESWT in cases diagnosed with intercostobrachial neuralgia after mastectomy. Subjects and methods. A prospective, single-blind, randomized controlled trial registered with the clinical trials registry (NCT06452615) included 52 female patients aged 40 to 65 years suffering from intercostobrachial neuralgia post-modified radical mastectomy. Patients were randomly assigned to the study group (ESWT group), which received two sessions of ESWT per week in addition to routine medical treatment, and the control group, which received only routine medical treatment. The treatment lasted for eight weeks. The visual analog scale (VAS), Douleur Neuropathique 4 questionnaire (DN4), and goniometer were used to measure pain intensity, neuropathic pain (primary outcome), and shoulder range of motion (ROM) (secondary outcome) at baseline (pre-treatment), and at the 4th and 8th weeks post-treatment in both groups. Results. Both groups demonstrated a substantial reduction in VAS and DN4 scores, while flexion and abduction ROM showed significant improvement (p < 0.001) at post-I and II stages compared to pre-treatment. The between-group comparison revealed that VAS and DN4 scores were significantly reduced (p < 0.05), whereas flexion and abduction ROM were significantly improved (p < 0.01) in the ESWT group compared to the control group at post-I and II treatments. Conclusion. ESWT can effectively improve intercostobrachial neuralgia post-mastectomy.