Sixty-four adults with upper-trapezius myofascial pain syndrome were randomized to Focused-extracorporeal shockwave therapy (fESWT) (n=32) or sham-fESWT (n=32). The intervention was delivered once weekly for four weeks (fESWT: 1,200 shocks at 4 Hz, 0.10–0.232 mJ/mm²; sham: probe near the trigger point, 300 shocks at 4 Hz, 0.03 mJ/mm²). The primary outcome was resting pain (VAS). Secondary outcomes included shear-wave elastography–derived shear modulus at the trigger point and aponeuroses, and the Neck Disability Index (NDI). Outcomes were measured at baseline, immediately after each session, two weeks, and four weeks. Overall, the results of the study revealed greater acute reductions in trigger-point stiffness and delayed reductions in lower-aponeurosis stiffness with fESWT, along with consistent VAS reductions after every session; NDI improved in both groups without a between-group difference. These findings suggest fESWT meaningfully reduces pain and selected stiffness metrics beyond sham, while functional gains may also reflect placebo/contextual effects.