A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: Preliminary research for clinical practice guidelines

Abstract

BackgroundPatients seek Korean Medicine (KM) treatment for a broad range of complaints in Korea, but predominantly for musculoskeletal disorders. We investigated lumbar Intervertebral Disc Displacement (IDD) practice patterns of Korean Medicine doctors (KMDs) within a hospital/clinic network specializing in KM treatment of spinal disorders through survey of diagnosis and treatment methods.MethodsQuestionnaires on clinical practice patterns of KM treatment for lumbar IDD were distributed to 149 KMDs on January 25th, 2015. The questionnaire included items on sociodemographic characteristics, clinical practice patterns, and preferred method of lumbar IDD diagnosis and treatment. KMDs were asked to grade each treatment method for absolute and relative importance in treatment and prognosis, and safety.ResultsA total 79.19 % KMDs (n = 118/149) completed the survey, and results showed that integrative care mainly consisting of acupuncture, herbal medicine, Chuna manipulation, and pharmacopuncture was administered to IDD patients. The participant KMDs largely relied on radiological findings (MRI and X-ray) for diagnosis. ‘Eight principle pattern identification’, ‘Qi and Blood syndrome differentiation’ and ‘Meridian system syndrome differentiation’ theories were generally used for KM syndrome differentiation. The most frequently prescribed herbal medication was Chungpa-jun, and most commonly used Chuna technique was ‘sidelying lumbar extension displacement treatment’. IDD patients received 1.9 ± 0.3 treatment sessions/week, and KMDs estimated that an average 9.6 ± 3.5 weeks were needed for 80 % pain relief.ConclusionsThis is the first study to investigate expert opinion on KM treatment of IDD. Further randomized controlled trials and clinical guidelines based on clinical practice patterns of KM are called for.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0956-1) contains supplementary material, which is available to authorized users.

Usage report of pharmacopuncture in musculoskeletal patients visiting Korean medicine hospitals and clinics in Korea

“…Analysis of previous clinical studies on pharmacopuncture shows that per acupoint and total pharmacopuncture volume are highly variable from 0.01 to 0.5 cc with one study reporting injection of 3.5 cc intra-articularly, and from 0.01 to 1.5 cc, respectively [15]. Meanwhile, a recent survey on pharmacopuncture use for IDD in KMDs reported ranges between 1.3 and 3.5 cc, likewise displaying a wide range [12]. While these figures may be a reflection of differences in disease, patient symptoms or severity, it may also be taken as an indication of absence of a standardized procedure.…”

“…In addition, this study was unable to collect data on the volume of pharmacopuncture solution used for treatment or the number of acupoints to which the treatment was applied. Still, results of a survey on KMDs employed at the current study sites that 2.9–5.8 acupoints were chosen for pharmacopuncture in IDD patients with 1.2–3.9 cc of pharmacopuncture solution injected at each session may be of reference [12]. …”

“…This is consistent with reports that Korean medicine (KM) is used most commonly for musculoskeletal disorders in Korea [8], and pharmacopuncture is also considered to be used mainly for musculoskeletal disorders in light of previous reports on the effect of pharmacopuncture for such disorders as lumbar intervertebral disc displacement (IDD) [9], degenerative knee osteoarthritis [10], and ankle sprain [11]. Moreover, according to a recent survey on practice patterns of IDD treatment, 95.9 % of responding Korean medicine doctors (KMDs) replied that they incorporated pharmacopuncture in their practice for lumbar IDD, suggesting that pharmacopuncture is commonly used for IDD [12]. A clinical guideline developed in Korea also recommends bee venom, Soyeom (消炎), Joongseongouhyul (中性瘀血), and Shinbaro pharmacopuncture for IDD at recommendation level B [13].…”

“…Although the abovementioned survey on IDD was an investigation on pharmacopuncture use [12], usage amounts were estimates based on KMD opinion and not supported by concrete data sources such as medical records. Due to paucity of investigations on pharmacopuncture type, application, duration, and dosage, there is increased difficulty in standardization of pharmacopuncture administration method and development of clinical practice guidelines.…”

Integrative Medicine for Postoperative Patients: A Survey of Korean Medicine Doctors

“…The number of inpatients with stroke treated using such integrative medicine has incrementally increased [4]. In addition, the KM hospitals particularly provide care for patients with musculoskeletal disorders in Korea and several US hospitals use integrative medicine for the treatment of patients with spinal disorders [5]. Clinical trials have also been conducted using different methodologies including the protocol for a prospective observational study using integrative medicine in children with cerebral palsy, protocol of three-armed randomized controlled trial for symptomatic lumbar spinal stenosis, and case series of prescribing herbal medicine and gefitinib for non-small-cell lung cancer patients [6–8].…”