Focused Shockwave Therapy for Neck and Shoulder Myofascial Pain

Inclusion Criteria: * Adults older than 20 years. * Clinical diagnosis of nonspecific neck and shoulder pain primarily arising from muscles and soft tissues in the upper trapezius or levator scapulae region, as determined by a physical medicine and rehabilitation physician. * Neck and shoulder pain lasting for at least 3 months. * Neck Disability Index score greater than 5. * No use of analgesic medication or muscle relaxants within the previous month. * No injection therapy, physical therapy, or other treatment for neck and shoulder pain within the previous month. * Ability to understand the study procedures and provide written informed consent. Exclusion Criteria: * Neck or shoulder pain caused by a neurologic disorder, including cervical radiculopathy. * Clinical or imaging diagnosis of cervical degenerative joint disease. * History of a rheumatic disease, including rheumatoid arthritis or systemic lupus erythematosus. * History of head or neck trauma. * History of cervical spine surgery. * History of whiplash injury. * Pregnancy. * Current or previous malignancy considered clinically relevant to shockwave therapy. * Bleeding disorder. * Current use of anticoagulant medication, including warfarin. * Acute inflammation or infection at the treatment site. * Implanted cardiac pacemaker or implantable cardioverter-defibrillator. * Any other condition judged by the study physician to make participation or focused shockwave therapy inappropriate or unsafe.