Combination shock wave therapy and core muscle training reduced analgesic dependence in chronic low back pain: A retrospective cohort analysis of multimodal rehabilitation versus pharmacotherapy alone

Abstract: Background: Few studies examine combined shockwave and core training for chronic low back pain (CLBP) analgesic dependence. Objectives: This study compared multimodal rehabilitation (shock wave therapy plus core muscle training) with pharmacotherapy alone for analgesic dependence in CLBP patients. Methods: Clinical data were retrospectively collected from 187 consecutive CLBP patients admitted to Jiangbin Hospital of Guangxi Zhuang Autonomous Region between January 2024 and June 2025. After exclusion, 184 patients were enrolled and divided into a multimodal rehabilitation group (shock wave therapy, core muscle exercises and routine medications; n=94) and a monotherapy group (pharmacotherapy only; n=90). 1:1 propensity score matching (PSM) produced 86 matched cases per group. The primary endpoints were analgesic dosage and the incidence of analgesic dependence. Secondary outcomes included the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), back extensor endurance, side-bridge holding time, lumbar range of motion, Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores and adverse events. Multivariate logistic regression was performed to identify independent predictors of analgesic dependence in CLBP patients. Results: After PSM, baseline characteristics were balanced between groups (all P > 0.05). At 12-week follow-up, the multimodal rehabilitation group showed lower analgesic dosage and analgesic dependence rate than the medication-only group (both P < 0.05). Both groups showed improvements in VAS, ODI, HAMA, and HAMD scores (all P < 0.05), with the multimodal group showing better outcomes (all P < 0.001). The multimodal group also exhibited greater enhancements in Sorensen test time, side-bridge duration and lumbar range of motion (all P < 0.001). No significant between-group difference in adverse events was observed (P = 0.109). Therapeutic strategy and baseline analgesic dosage were independent predictors of analgesic dependence (all P < 0.05). Conclusion: Multimodal rehabilitation combining shock wave therapy and core muscle training is more effective in reducing analgesic dependence in CLBP patients.