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The Somatic Connection  |   October 2017
Intervertebral Herniation Pain Reduced by Inpatient Manual Therapy and Traditional Korean and Chinese Medicine
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   October 2017
Intervertebral Herniation Pain Reduced by Inpatient Manual Therapy and Traditional Korean and Chinese Medicine
The Journal of the American Osteopathic Association, October 2017, Vol. 117, 668-669. doi:10.7556/jaoa.2017.128
The Journal of the American Osteopathic Association, October 2017, Vol. 117, 668-669. doi:10.7556/jaoa.2017.128
Shin JS, Lee J, Kim M, et al. The short-term effect of integrated complementary and alternative medicine treatment in inpatients diagnosed with lumbar intervertebral disc herniation: a prospective observational study. J Alt Comp Med. 2016;22(7):533-543. 
In a prospective observational study, hospital-based South Korean researchers evaluated the combination of manual medicine with traditional Korean medicine in the treatment of patients with lumbar intervertebral disk herniation. Inclusion criteria were hospitalization due to low back pain (LBP) and/or leg radiculopathy diagnosed by magnetic resonance imaging or physical examination. Exclusion criteria included main symptom other than LBP or cause of LBP not related to intervertebral disk herniation, such as spinal tumors, pregnancy, urolithiasis, or rheumatoid arthritis. 
A total of 1178 patients with LBP were screened, and 524 completed the study. Chuna manipulation (described as gentle high-velocity, low-amplitude thrust) was applied 3 to 5 times per week in addition to herbal medicine, acupuncture, and bee venom pharmacopuncture. Conventional medical treatment, including analgesics and nerve blocks, was given to 151 patients (29%). The mean (SD) length of hospital stay for the patients in this study was 24.4 (13.2) days, reflecting the more holistically oriented treatment used in this particular medical setting. (In contrast, the mean hospital stay for intervertebral disk herniation in the United States is 2.6 days and is virtually all related to surgery.1) Outcome measures were a numeric rating scale score for LBP and leg pain, Oswestry Disability Index (ODI), and patient global impression of change. Change was compared with minimal clinically important difference in LBP or leg pain based on years of accumulated data gathered at this private hospital. 
Results showed statistically significant reductions in the numeric rating scale scores for LBP (mean [SD], 3.18 [2.29]; 95% CI, 2.99-3.38) and radiating leg pain (mean [SD], 2.61 [2.60]; 95% CI, 2.38-2.83), and a reduction in ODI score (mean [SD], 19.45 [19.53]; 95% CI, 17.77-21.12). Improvement was seen in 274 patients (51.5%) over minimal clinically important difference in both the numeric rating scale and ODI. 
Although this study did not have a placebo control group, the sample was relatively large. The novel combination approach of a manual medicine modality similar to osteopathic manipulative treatment along with herbal and acupuncture applications in an inpatient setting may have implications for implementing such a program in the US health care system. 
References
Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Rockville, MD: Agency for Healthcare Research and Quality; 2011.