Therapeutic outcomes of the integrative care package for back pain with disc herniation

Abstract:The goal of this prospective observational cohort study was to investigate therapeutic outcomes of the integrative care package for back pain with disc herniation. We selected 150 consecutive low back pain patients (20 to 60 years old) with lateral radicular pain to lower extremities diagnosed as lumbar disc herniation (prolapse~extrusion) confirmed by MRI since November 2006. The visual analogue scale of radicular pain was 5 or higher. Care package comprises Korean medicine, Chuna (a Korean style systemic manipulative therapy), acupuncture, bee venom acupuncture (subcutaneous, or intramuscular). Treatment schedule for a total of 24 weeks involves weekly clinic visits during which relevant therapies are carried out and the medicine for the following week is given. Outcome measures are Visual analogue scale (VAS) of radicular pain, Owestry Disability Index (Korean Version) and SF-36, which are assessed at baseline, 2,4,8,12, and 24 week. Clinical data were obtained at baseline from physician questionnaire and examination. This study is completed on September 2007. Of 150 patients, 128 (85.3%) remain in the 24 week care plan and 78 of them (60.93%) have been recommended for surgical management at other hospitals, but sought after a non-surgical alternative. The mean scores of VAS, ODI and SF-36 at baseline were 7.436, 41.47 and 35.4 respectively. At 24 week, they were 1.067, 11.84, and 66.48 respectively. The results showed crescendo and decrescendo pattern. Pain and functional disability decreases as the patients get more treatments.

Perspective: While this observational study has no control group, we are certain that it is feasible to carry out such a prospective observational study to investigate the outcome of integrative multi-care package. Therefore, we urge more hospitals and clinics to begin feasible systematic investigations.