Extracorporeal shockwave therapy for zoster-associated pain: A retrospective analysis based on spinal musculoskeletal imbalance

Herpes zoster-associated pain (ZAP) is a common sequela of varicella-zoster virus reactivation, particularly among older adults. Emerging evidence suggests that spinal musculoskeletal homeostasis (SMH) imbalance may contribute to localized degenerative changes associated with ZAP. Although extracorporeal shockwave therapy (ESWT) has shown promise in musculoskeletal rehabilitation, its efficacy in treating ZAP from the perspective of SMH remains underexplored. This retrospective study aims to evaluate the effectiveness of ESWT in ZAP patients with musculoskeletal imbalance as assessed by imaging-based SMH scores. This retrospective study reviewed clinical records of 82 hospitalized patients diagnosed with spinal-segmental ZAP between May 2023 and June 2024. Based on their treatment protocols, patients were divided into 2 groups: those receiving conventional treatment (C group, n = 41) and those receiving ESWT in addition to conventional therapy (E group, n = 41). Pain scores (Numerical Rating Scale, NRS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and Spinal Musculoskeletal Imaging Score (SMIS) were evaluated at 4 time points: 48 hours post-admission, after 1 week of hospitalization, and at 1 and 3 months post-discharge. Statistical analysis was performed using t tests and chi-square tests, with significance set at P < .05. Both groups had comparable baseline characteristics. After 1 week of treatment, both groups showed improvement in pain and sleep quality, but the ESWT group demonstrated a significantly greater improvement in PSQI (P < .05). At 1 month post-discharge, NRS, PSQI, and SMIS scores were significantly better in the ESWT group (P < .05). By 3 months, these differences further increased, with statistically significant reductions in all 3 indicators in the ESWT group (P < .01). The incidence of postherpetic neuralgia (PHN) was lower in the ESWT group (2 cases vs 13 cases in the control group). Retrospective analysis suggests that ESWT may be an effective adjunctive therapy for ZAP patients with spinal musculoskeletal imbalance, significantly improving pain, sleep quality, and spinal musculoskeletal structure, while potentially reducing the risk of PHN. These findings support the integration of ESWT into comprehensive ZAP management strategies based on musculoskeletal health assessments. Further prospective studies are needed to validate these results.