OBJECTIVES: To compare the efficacy of extracorporeal shock wave therapy versus standard care (ultrasound plus hot pack plus self-stretch-exercises) in treatment of neck and upper back myofascial pain syndrome. DESIGN: Single-blind randomised clinical trial. SETTING: Outpatients setting. SUBJECTS: Patients with neck and upper back myofascial pain. INTERVENTION: Participants were randomly allocated into shock wave group (n = 24), standard care (ultrasound plus hot pack plus self-stretch-exercises) group (n = 24) and control (self-stretch-exercises) group (n = 24) for four weeks. MAIN MEASURES: The primary outcomes were pain intensity (visual analogue scale), pain pressure threshold (algometer) and disability (neck disability index). Measures were performed at baseline (week 0), week 1 and post-intervention (week 4). RESULTS: Shock wave and ultrasound improved visual analogue scale (7.50 +/- 1.71 to 5.72 +/- 2.20 and 6.22 +/- 2.54 to 4.95 +/- 2.86, respectively, p = 0.083) and disability index (54.24 +/- 15.53 to 39.04 +/- 19.58 50.23 +/- 19.57 to 32.10 +/- 18.34, respectively, p = 0.495) similarly at first week examinations that were significantly higher than control (p < 0.05). In week 4 measurements, additional improvements were achieved concerning visual analogue scale and disability index in the shock wave (-4.00 +/- 2.22 and -20.24 +/- 16.56, respectively) and ultrasound (-2.18 +/- 2.71 and -21.79 +/- 10.56, respectively) groups. However, visual analogue scale improved more significantly in shock wave group than ultrasound group in fourth week measurements (p = 0.012). CONCLUSION: Extracorporeal shock wave therapy was more effective in controlling of the pain intensity compared to ultrasound one month after treatment. However it had no superiority over ultrasound in improving neck disability index at this time point. TRIAL REGISTRATION: www.irct.ir IRCT201608154104N5, registered 2016-09-25.

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