Abstract
BackgroundLow back pain is a common symptom and continuous or recurrent pain results in chronic low back pain (CLBP). While many patients with CLBP have tried various treatments, complementary and alternative medicine including acupuncture and herbal medicine is one of the commonly used treatments. Palmijihwang-hwan is a herbal medicine used frequently in clinical practice but there has been no report of the efficacy, safety, or cost-effectiveness analysis of Palmijihwang-hwan for CLBP.MethodsThis study is a randomized, assessor-blinded, multicenter, clinical trial with two parallel groups. Four Korean medicine hospitals will recruit 84 participants and randomly allocate them into the control or treatment group in a 1:1 ratio. The control group will receive acupuncture treatment at 11 local and 4 distal acupuncture points for 20 min twice a week for 6 weeks. The treatment group will receive the same acupuncture treatment as the control group and also take Palmijihwang-hwan for 6 weeks. The primary outcome will be the change in visual analog scale (VAS) score between baseline (visit 1) and completion of the intervention (visit 12), and secondary outcomes will be pain-related clinical relevance (minimal clinical important difference or the proportion of the participants who decrease more than 30, or 50% on VAS), disability (Roland and Morris Disability Questionnaire), quality of life (EuroQol-5D), global assessment (Patient Global Impression of Change), and economic analysis (cost-effectiveness and cost-utility analysis). Additionally, safety will be assessed.DiscussionThe results of our study will provide the clinical evidence about the efficacy, safety, and cost-effectiveness analysis of Palmijihwang-hwan for CLBP. There will be a chance to provide multiple subdivided influence of this treatment with various outcome measures, but lack of placebo is our limitation.Trial registrationClinical Research Information Service, KCT0002998. Registered on 12 July 2018.
Highlights
Low back pain is a common symptom and continuous or recurrent pain results in chronic low back pain (CLBP)
Deficits in and poor satisfaction with conventional treatments [5] for CLBP have led to attempts to treat CLBP using nonpharmacologic [6] or complementary and alternative medicine (CAM)
Various studies have reported on the effects on pain [10] and the pragmatic aspects [11] of acupuncture in treating CLBP and some have suggested that acupuncture has more effect on the reduction of pain and bothersomeness than sham control in patients with CLBP [12]
Summary
Low back pain is a common symptom and continuous or recurrent pain results in chronic low back pain (CLBP). While many patients with CLBP have tried various treatments, complementary and alternative medicine including acupuncture and herbal medicine is one of the commonly used treatments. Most patients with acute LBP recover within 4 weeks but recurrences are common [3]. In the case of insufficient treatment and management, continuous pain results in chronic LBP (CLBP), which is known to be related to various factors including psychological distress and psychiatric disorders [4]. In Korean medicine, several treatments including acupuncture [7], electroacupuncture [8], and pharmacopuncture such as bee venom [9] have been examined as a treatment for LBP, and several studies have reported therapeutic effects. Studies on the effects of adjuvant Korean herbal medicines on CLBP, in combination with acupuncture, are rare
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