Survey of Integrative Treatment Practices of Korean Medicine Doctors for Cervical Disc Herniation: Preliminary Data for Clinical Practice Guidelines

Abstract

A survey study was conducted in Korean medicine doctors who provide nonsurgical integrative treatment for cervical disc herniation (CDH) at spine-specialty hospitals to assess usual treatment practices, diagnosis and treatment methods, and related adverse events for CDH. The questionnaire was jointly developed by clinical experts and methodology experts and was administered to 197 Korean medicine doctors (response rate: 84.9% (n = 197/232)) practicing at spine-specialty Korean medicine hospitals for analysis of general sociodemographic information, practice patterns of CDH including diagnosis and treatment strategies, CDH prognosis, and treatment safety. The average clinical experience of respondents was 9.3±6.4 years, and 4.0±1.8 weeks were regarded to be needed for CDH pain to decrease by 50% and 9.1±3.4 weeks to decrease by 80%. Eight-Principle Pattern and Meridian System Identification were the most commonly used Korean medicine syndrome differentiation methods, and CDH was most often considered to be a result of Qi stagnation and Blood coagulation. The Spurling test was reported to be important in physical examination, and magnetic resonance (MR) images were mostly used for diagnosis and treatment of CDH of various diagnostic tools. Treatment mainly consisted of a nonsurgical, integrative multimodal approach comprising acupuncture, pharmacopuncture, herbal medicine, and Chuna manual therapy. Shinbaro pharmacopuncture and Chungpa-jun, which are well-established herbal treatments supported by evidence, were considered to be of high importance in CDH treatment. With regard to safety, acupuncture was considered to be the safest, while bee venom pharmacopuncture was of highest concern due to potential hypersensitivity. This study is the first report to investigate current practice patterns and approach of Korean medicine doctors to CDH treatment. This data may be of significance to Korean medicine doctors in drawing clinical guidelines and conducting randomized controlled trials (RCTs) to generate high-level evidence on the effectiveness of nonsurgical integrative medicine treatments for CDH.

A Pragmatic Randomized Controlled Trial on the Effectiveness and Safety of Pharmacopuncture for Chronic Lower Back Pain

“… 8 In decreasing order, the most frequently used types of pharmacopuncture in this study included Shinbaro 2, hwangryunhaedok-tang, Shinbaro 1, harpagophytum procumbens, hominis placenta, jungsongouhyul, and muscle relaxation. This finding is consistent with the results of a questionnaire survey conducted by clinicians in Korea who treated lumbar spinal stenosis 27 and cervical disc herniation 28 in spine-specialty hospitals. Shinbaro 2, which comprises nine herbal medicinal ingredients is used to relieve pain or treat inflammation in musculoskeletal disorders.…”

A Comparative Study of the Effectiveness of Pharmacopuncture Therapy for Chronic Neck Pain: A Pragmatic, Randomized, Controlled Trial

“…In our study, the most commonly used PPT types were Shinbaro 2, Harpagophytum procumbens, and Shinbaro 1. This is consistent with the trends observed in surveys of clinicians treating cervical disc herniation [ 34 ] and lumbar spinal stenosis [ 35 ] at spine speciality hospitals in Korea. Shinbaro 2 comprises nine crude herbs (Paeonia lactiflora Pall.…”

“…To overcome this limitation, a resident blinded to the group allocation and not involved in the intervention performed the outcome evaluation to minimize bias. Additionally, the PPT types were not diverse with regard to published articles of the current status of frequently used PPT for spinal disease [ 34 , 35 ]. Moreover, the actual clinical settings were not accurately reflected because the study sites did not include clinics.…”

Clinical Applications of Bee Venom Acupoint Injection

“…Due to the bioactive compounds isolated from BV and its pharmacological actions, BVA is an effective treatment that is commonly used. Numerous studies of BVA have emerged in the last 20 years [ 12 , 13 ], and it has gradually become a popular alternative treatment [ 14 , 15 , 16 ]. BVA has mostly been used to treat intervertebral disc disease [ 14 , 17 , 18 ], neuropathic pain [ 19 ], arthritis [ 20 , 21 ], and skin diseases [ 22 , 23 ].…”