Long-Term Course of Failed Back Surgery Syndrome (FBSS) Patients Receiving Integrative Korean Medicine Treatment: A 1 Year Prospective Observational Multicenter Study

Abstract

BackgroundWith increase of spine surgeries, failed back surgery syndrome (FBSS) prevalence is also rising. While complementary and alternative medicine (CAM) is commonly used for low back pain (LBP), there are no studies reporting use of integrative Korean medicine in FBSS patients.MethodsPatients with pain continuing after back surgery or recurring within 1 year and visual analogue scale (VAS) of LBP or leg pain of ≥6 (total n = 120) were recruited at 2 hospital sites from November 2011 to September 2014. Weekly sessions of integrative Korean medicine treatment were conducted for 16 weeks (herbal medicine, acupuncture/electroacupuncture, pharmacopuncture/bee venom pharmacopuncture, and Chuna manual therapy) with additional follow-ups at 24 weeks and 1 year. Outcome measures included VAS of LBP and leg pain (primary outcome), Oswestry Disability Index (ODI), Short-Form 36 (SF-36), medical use, and patient global impression of change (PGIC).ResultsVAS of LBP and leg pain improved at 6 months (LBP from 6.1±2.0 at baseline to 2.9±2.3; and leg pain from 5.4±2.6 to 2.4±2.5, respectively). Eighty patients (66.7%) showed improvement of 50% or more in main pain of LBP or leg pain from baseline. Disability and quality of life also improved at 6 months (ODI from 41.3±12.3 at baseline to 23.6±13.6; and SF-36 from 42.8±14.5 to 62.7±16.8). At 1 year follow-up, conventional medical management use decreased, improvement in pain and disability was maintained, and 79.2% reported improvement of PGIC.ConclusionsDespite limitations as an observational study, integrative Korean medicine treatment showed positive results in pain, function, and quality of life of FBSS patients.

Clinical Applications of Bee Venom Acupoint Injection

“…More and more people are affected by chronic neck pain or lower back pain. These patients are often prescribed NSAIDs [ 80 ] or alternative treatments such as BVA [ 81 , 82 ]. In one recent blinded human trial, 54 people suffering from chronic lower back pain were assigned to either BVA or sham acupuncture groups.…”

Acupotomy for the treatment of lumbar spinal stenosis

“…[11,12] More importantly, the prevalence of postoperative “failed back surgery syndrome” has also increased, prompting clinicians and patients to seek more effective and safe treatment options. [13] Therefore, minimally invasive procedures for treating LSS has gained attention. [14,15]…”

“…Given these characteristics, acupotomy may have different effects on LSS than conventional acupuncture [21,22] ; in particular, the efficacy and safety profile may differ as it has greater invasiveness than acupuncture, but lower invasiveness than surgery. Because of the limitations of conventional treatments for LSS, [9–13] establishing evidence of the efficacy and safety of new treatment options, such as acupotomy, is important for both clinicians and patients. Therefore, this review was conducted to analyze the current evidence of the efficacy and safety of acupotomy in LSS.…”

Acupotomy for the treatment of lumbar spinal stenosis

“…[11,12] More recently, the issue of so-called “failed back surgery syndrome” has emerged, presenting challenges and hesitation in the treatment of LBP patients. [13] Therefore, minimally invasive operative management of LSS has gained popularity. [14,15]…”