Massage, laser and shockwave therapy improve pain and scar pruritus after burns: a systematic review.

Burn scars can be painful and intensely itchy for a long time after the wound itself has healed, and physiotherapists commonly use hands-on and device-based treatments to help. This systematic review pooled results from fifteen randomised trials, involving 780 adults with burn scars, comparing non-invasive therapies such as massage, laser, shockwave therapy and silicone against control conditions. Across the pooled trials, massage, laser and shockwave therapy were each associated with reductions in pain and itch intensity compared with control treatment, with laser showing the largest reported reductions. However, when it came to scar elasticity and blood vessel changes, massage, shockwave therapy and silicone showed negligible or unclear benefits.

The authors rated the overall quality of evidence as low to moderate, meaning these results are encouraging but not yet firmly established, and the review does not show that combining therapies adds extra benefit beyond what was tested individually.

If you've had a burn, you probably know that the scar itself can be uncomfortable long after the skin has healed, sometimes with ongoing pain or itching that affects daily life. Researchers wanted to know whether treatments like massage, laser therapy, shockwave therapy or silicone products actually help with these symptoms. Looking across fifteen small-to-moderate sized studies with a total of 780 people, this review found that massage, laser and shockwave therapy were each linked to less pain and less itching in burn scars compared with people who didn't receive that treatment.

Laser therapy showed the largest reductions in the pooled data. However, none of these treatments, including massage, shockwave therapy or silicone, showed clear improvement in how stretchy the scar was or in blood flow to the area. The evidence behind these findings is described as low to moderate quality, so while the pattern is encouraging, it isn't yet strong enough to say definitively how well these treatments work or for how long the benefits last.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians managing burn scar symptoms, a recurring question is whether non-invasive adjuncts like massage, laser or shockwave therapy make a measurable difference to patient-reported pain and pruritus, given how commonly these are used in scar rehabilitation. This review pooled data from fifteen randomised trials totalling 780 participants and found statistically significant reductions in both pain and pruritus intensity on 0-to-10 scales for massage, shockwave therapy and laser, each compared with a control condition, with laser showing the largest mean differences (pain: -4.0, 95% CI -6.0 to -2.0; pruritus: -4.8, 95% CI -6.1 to -3.5). Importantly, these active therapies were each compared against control rather than against each other, so the review does not establish whether one modality outperforms another.

For structural outcomes, scar elasticity and vascularisation, massage, shockwave therapy and silicone showed negligible or unclear effects, indicating that symptom relief and tissue-level change may not track together. The authors rated evidence quality as low to moderate throughout, and the review does not report whether benefits persisted beyond the intervention period as a separate confirmed finding, so applying these results to long-term scar management or to specific burn severities warrants caution.