2nd Edition of Public Health World Conference (PHWC) 2026

Abstract

Background

Greater trochanteric pain syndrome (GTPS) is one of the most prevalent causes of lateral hip pain, particularly in middle-aged women. Extracorporeal shock wave therapy (ESWT) has emerged as a non-invasive alternative to corticosteroid injections. This study aimed to investigate whether concurrent use of NSAIDs or tramadol-containing compound analgesics (Ultracet®) influences the clinical outcomes of focused ESWT in patients with GTPS.

Methods

A single-center retrospective observational study was conducted at the Department of Orthopedic Surgery, CHA Bundang Medical Center. Medical records of 133 patients diagnosed with GTPS who underwent focused ESWT were reviewed. Patients were included if pre- and post-treatment Visual Analogue Scale (VAS) scores were available. Based on attending physician prescription records, patients were stratified into four medication groups: no medication (x; n = 46), NSAIDs only (n; n = 38), Ultracet® only [tramadol/acetaminophen combination] (u; n = 11), and NSAIDs plus Ultracet® (b; n = 38). The primary outcome was the VAS improvement rate (%), calculated as [(pre-treatment VAS − post-treatment VAS)/pre-treatment VAS × 100]. Number of ESWT sessions was analyzed as a continuous variable and categorized as 1, 2–3, or ≥4 sessions.

Results

The overall mean VAS improvement rate was 66.4 ± 17.2% (median 70%; IQR 50–80%; range 20–100%). No statistically significant difference in VAS improvement rate was observed among the four medication groups (Kruskal-Wallis H = 0.243, p = 0.970). Binary comparison between patients with and without any concurrent medication likewise revealed no significant difference (Mann-Whitney U = 2060, p = 0.778). Mean VAS improvement rates across groups were remarkably similar, ranging from 65.5% (Ultracet® only) to 66.8% (NSAIDs only).

Regarding treatment sessions, a statistically significant negative correlation was identified between the number of ESWT sessions and VAS improvement rate (Spearman r = −0.199, p = 0.022), with patients undergoing ≥4 sessions showing a lower mean improvement (60.9%) compared to those receiving 1 session (71.2%) or 2–3 sessions (68.4%). Kruskal-Wallis analysis across session-count groups was significant (H = 6.448, p = 0.040); however, post-hoc pairwise comparisons did not reach Bonferroni-corrected significance, suggesting that the observed association likely reflects reverse causality—i.e., patients with insufficient initial response receiving more sessions.

Conclusion

Concurrent use of NSAIDs or tramadol-based analgesics during focused ESWT did not significantly affect treatment outcomes in patients with GTPS. These findings suggest that clinicians need not routinely discontinue NSAIDs prior to ESWT in this population. The comparable outcomes between NSAIDs and tramadol groups further indicate that analgesic choice does not differentially influence ESWT response.