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.
Highlights
Cervical disc herniation (CDH) is a condition where inflammation related to the herniated disc irritates the cervical nerves and/or compresses the nerve root, incurring pain or numbness of the upper extremity that may radiate extensively to the neck, shoulder, hand, and fingers [1, 2]
According to the Healthcare Big Data Hub provided by the Korean Health Insurance Review & Assessment Service (HIRA), 1,939,400 patients presented with CDH in 2016, and national health insurance expenditure totaled 316 billion Korean won
Nonsurgical treatment is recommended as first-line treatment for pain management in the absence of emergency surgery indications, and while conventional treatments such as medication and injections are extensively used for pain relief and improvement of quality of life [9, 10], patient interest in integrative medicine approaches for CDH treatment is increasing [11], partly due to the limited evidence for effectiveness of conventional treatment and associated adverse events [7]
Summary
Cervical disc herniation (CDH) is a condition where inflammation related to the herniated disc irritates the cervical nerves and/or compresses the nerve root, incurring pain or numbness of the upper extremity that may radiate extensively to the neck, shoulder, hand, and fingers [1, 2]. Nonsurgical treatment is recommended as first-line treatment for pain management in the absence of emergency surgery indications, and while conventional treatments such as medication and injections are extensively used for pain relief and improvement of quality of life [9, 10], patient interest in integrative medicine approaches for CDH treatment is increasing [11], partly due to the limited evidence for effectiveness of conventional treatment and associated adverse events [7] These data support the practice of low prioritization of surgery in decision-making for CDH and highlight the significance of timely utilization of nonsurgical treatments within an integrative medicine model for effective pain management and favorable patient prognosis
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