Comparison of Efficacy between Medial Branch Block and Collaborative Treatment with Acupuncture on Acute Low Back Pain

급성 요통의 내측지 차단술 단독 치료와 침을 병행한 협진 치료의 효과 비교

  • Yi, Joo-Il (Dept. of Internal Medicine, Jain Medi Hospital) ;
  • Na, Yu-Jin (Dept. of Internal Medicine, Jain Medi Hospital) ;
  • Kim, Byung-Hean (Dept. of Orthopedics, Jain Medi Hospital) ;
  • Ryu, Eun-Kyung (Dept. of Oriental Rehabilitation Medicine, Jain Medi Hospital)
  • 이주일 (자인메디병원 한방내과) ;
  • 나유진 (자인메디병원 한방내과) ;
  • 김병헌 (자인메디병원 정형외과) ;
  • 류은경 (자인메디병원 한방재활의학과)
  • Published : 2013.04.30

Abstract

Objectives : The purpose of this study was to compare the effects of acupuncture and medial branch block(collaborative treatment) with just medial branch block regarding acute low back pain. Methods : Forty inpatients who received treatment between January 2012 and February 2013 were divided into 2 groups. The East-West treatment group(EW group, n=20) received one treatment of medial branch block and then acupuncture afterwards. The Western treatment group(W group, n=20) received one treatment of medial branch block. Both groups continued to receive manual therapy 3 times a week. Evaluations were made before medial branch block, 7 days after, and 14 days after using the Numerical Rating Scale(NRS). Results : Compared to before treatment, the NRS score of both EW and W groups after 7 and 14 days of treatment significantly decreased(p=0.0001). But only the EW group showed additional improvement between days 7 and 14(p=0.005). Regarding group comparison, the NRS score of the EW group was significantly lower than the W group at 7 days(p=0.037), and even more at 14 days(p<0.0001). Conclusions : Although medial branch block alone significantly improved acute low back pain, collaborative treatment with acupuncture was even more effective, with increased efficacy as time passed. Further research is recommended regarding the effects of collaborative treatment with acupuncture on acute low back pain.

Keywords

References

  1. Peterson CK, Bolton J, Humphreys BK. Predictors of improvement in patients with acute and chronic low back pain undergoing chiropractic treatment. J Manipulative Physiol Ther. 2012; 35(7):525-33. https://doi.org/10.1016/j.jmpt.2012.06.003
  2. Svendsen JH, Svarrer H, Laessoe U, Vollenbroek- Hutten M, Madeleine P. Standardized activities of daily living in presence of sub-acute low-back pain: A pilot study. J Electromyogr Kinesiol. 2013;23(1):159-65. https://doi.org/10.1016/j.jelekin.2012.08.006
  3. McCarberg BH. Acute back pain: benefits and risks of current treatments. Curr Med Res Opin. 2010;26(1):179-90. https://doi.org/10.1185/03007990903451348
  4. Klekot D, Zimny A, Czapiga B, Sąsiadek M. Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain - a case report and literature review. Pol J Radiol. 2012;77(4):72-6.
  5. Binder DS, Nampiaparampil DE. The provocative lumbar facet joint. Curr Rev Musculoskelet Med. 2009;2(1):15-24. https://doi.org/10.1007/s12178-008-9039-y
  6. Brummett CM, Cohen SP. Chapter 46 - Facet syndrome: facet joint injections, medial branch blocks, and radiofrequency denervation. In: Benzon HT, Raja SN, Fishman SM, Liu SS, Cohen SP, eds. Essentials of Pain Medicine. 3rd ed. Philadelphia: Elsevier; 2011:322-9.
  7. Saito T, Steinke H, Miyaki T, Nawa S, Umemoto K, Miyakawa K, Wakao N, Asamoto K, Nakano T. Analysis of the posterior ramus of the lumbar spinal nerve: the structure of the posterior ramus of the spinal nerve. Anesthesiology. 2013;118(1):88-94. https://doi.org/10.1097/ALN.0b013e318272f40a
  8. Bogduk N, Long DM. The anatomy of the so-called "articular nerves" and their relationship to facet denervation in the treatment of low-back pain. J. Neurosurg. 1979;51(2):172-7. https://doi.org/10.3171/jns.1979.51.2.0172
  9. Wasan AD, Jamison RN, Pham L, Tipirneni N, Nedeljkovic SS, Katz JN. Psychopathology predicts the outcome of medial branch blocks with corticosteroid for chronic axial low back or cervical pain: a prospective cohort study. BMC Musculoskeletal Disorders. 2009;10(1):22. https://doi.org/10.1186/1471-2474-10-22
  10. Manchikanti L, Boswell MV, Singh V, Derby R, Fellows B, Falco FJE, Datta S, Smith HS, Hirsch JA. Comprehensive review of neurophysiologic basis and diagnostic interventions in managing chronic spinal pain. Pain Physician. 2009;12(4):E71-120.
  11. Vas J, Aranda JM, Modesto M, Benítez-Parejo N, Herrera A, Martínez-Barquín DM, Aguilar I, Sánchez-Araujo M, Rivas-Ruiz F. Acupuncture in patients with acute low back pain: a multicentre randomised controlled clinical trial. Pain. 2012;153(9):1883-9. https://doi.org/10.1016/j.pain.2012.05.033
  12. Park JJ, Shin J, Choi Y, Youn Y, Lee S, Kwon S-R, Lee H, Kang M-H, Ha I-H, Shin I. Integrative package for low back pain with leg pain in Korea: a prospective cohort study. Complement Ther Med. 2010;18(2):78-86. https://doi.org/10.1016/j.ctim.2010.02.003
  13. 서보명, 윤종석, 김성웅, 이세연, 이경민, 배은정, 서정철, 임성철, 정태영, 한상원. 요통 환자의 한방단독치료와 한양방협진치료의 효과 비교. 대한침구학회지. 2003;20(6):140-7.
  14. Lee JH, Choi TY, Lee MS, Lee HJ, Shin BC, Lee HS. Acupuncture for Acute Low Back Pain. The Clinical Journal of Pain. 2013; 29(2):172-85. https://doi.org/10.1097/AJP.0b013e31824909f9
  15. 이승진, 신병철, 송근성, 황의형, 윤영주, 조현우. 근골격계 질환의 한양방협진치료 효과 연구에 대한 체계적 문헌 고찰. 한방재활의학과학회지. 2011;21(4):87-96.
  16. 남동우, 김행범, 양동훈, 임사비나, 김건식, 이두익, 이재동, 최도영, 이윤호. 동결견(凍結肩) 환자의 동서협진 치료의 임상효과 비교연구 - 견관절 가동운동범위(ROM) 변화를 중심으로-. 대한침구학회지. 2006;23(5):105-13.
  17. 김지혜, 남동우, 강중원, 김은정, 김갑성, 강성길, 이재동. 만성 요통에 대한 한의학적 평가 척도 개발을 위한 임상연구 실태조사. 대한침구학회지. 2009;26(6):215-24.
  18. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073-93. https://doi.org/10.1016/j.jpainsymman.2010.08.016
  19. 하인혁, 박원상, 우인, 김하늘, 고동현, 윤유석. 요각통 환자의 통증 평가에 있어서 수직, 수평선 Visual Analogue Scale과 Numerical Rating Scale 간의 상관관계. 한방재활의학과학회지. 2006;16(4):125-33.
  20. Edwards RR, Berde CB. Chapter 5 - Pain Assessment. In: Benzon HT, Raja SN, Molloy RE, Liu SS, Fishman SM, eds. Essentials of Pain Medicine and Regional Anesthesia. 2nd ed. Philadelphia:Elsevier; 2005:28-33.
  21. Lowry R. VassarStats: Statistical Computation Web Site. http://vassarstats.net. 2013.
  22. Uitenbroek D. Simple Interactive Statistical Analysis. www.quantitativeskills.com. 2013.
  23. Dunlop RB, Adams MA, Hutton WC. Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br. 1984;66(5):706-10.
  24. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591-614. https://doi.org/10.1097/00000542-200703000-00024
  25. Falco FJE, Manchikanti L, Datta S, Sehgal N, Geffert S, Onyewu O, Zhu J, Coubarous S, Hameed M, Ward SP, Sharma M, Hameed H, Singh V, Boswell MV. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician. 2012;15(6):E909-53.
  26. Kim KT, Park SW, Kim YB, Hong HJ, Kwon JT, Hwang SN. The Effect of Lumbar Medial Branch Block on Low Back Pain. Journal of Korean Neurosurgical Society. 2006;40(4):256-61.
  27. Celik B, Er U, Simsek S, Altug T, Bavbek M. Effectiveness of lumbar zygapophysial joint blockage for low back pain. Turk Neurosurg. 2011;21(4):467-70.
  28. Manchikanti L, Singh V, Falco FJE, Cash KA, Pampati V. Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Int J Med Sci. 2010;7(3):124-35.
  29. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007;10(3):425-40.
  30. Falco FJE, Manchikanti L, Datta S, Sehgal N, Geffert S, Onyewu O, Singh V, Bryce DA, Benyamin RM, Simopoulos TT, Vallejo R, Gupta S, Ward SP, Hirsch JA. An update of the systematic assessment of the diagnostic accuracy of lumbar facet joint nerve blocks. Pain Physician. 2012;15(6):E869-907.
  31. 최윤숙, 김용철, 신혜영, 이승윤, 박상현, 정승현. 술후 발생한 극심한 요통환자에서 후지내 측지 신경차단 치료. Korean Journal of Anesthesiology. 2009;56(5):574. https://doi.org/10.4097/kjae.2009.56.5.574
  32. Nam JR, Park SB, Yoon SW, Song YK. Significant Motion Factors Affecting the Outcome of a Medial Branch Block in Patients with Low Back Pain Developing after Trivial Trauma. Korean Journal of Spine. 2009;6(1):27-31.
  33. Da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LOP. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-24. https://doi.org/10.1503/cmaj.111271
  34. Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, Dragin AS, Milovanovic ND. Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study. Photomed Laser Surg. 2010;28(4):553-60. https://doi.org/10.1089/pho.2009.2576
  35. 송계화, 박기범, 이진석, 김대중. 급성기 요통의 침치료에 있어서 근위취혈과 원위취혈병용의 비교 연구. 대한침구학회지. 2006;23(4):61-8.
  36. 이윤규, 박서영, 전현정, 김성환, 김지현, 이세민, 김재수, 이경민, 이봉효, 정태영, 임성철. 급성기 요통에 대한 체침과 팔체질침의 치료 효과에 관한 비교 연구. 대한침구학회지. 2009;26(2):181-8.
  37. 정시영, 박재우, 신정미, 김지영, 윤인애. 급성기 요통에 대한 침치료와 우황, 우황, 사향약침 병행치료의 효과 비교연구. 대한침구학회지. 2011;28(4):105-10.
  38. 이진복, 임정균, 이형걸, 육태한, 김종욱. 요통환자의 침치료와 족침 병행치료에 대한 비교 연구. 대한침구학회지. 2011;28(4):1-7.
  39. Liu J, Li N. Clinical observation of a combination of acupuncture and drug administration for non-specific acute lumbar sprain. Journal of Acupuncture and Tuina Science. 2010;8(1):47-9. https://doi.org/10.1007/s11726-010-0047-2
  40. 고필성, 이원일, 조병진, 권신애, 이정우, 김민정, 서병관, 우현수, 백용현, 김재규, 박동석. 요천추부 염좌로 진단된 급성 요통 환자의 방사선학적 소견과 치료기간에 대한 임상적 고찰. 대한침구학회지. 2010;27(4):19-28.
  41. 정재훈, 김원우, 성익현, 이갑수, 조창영, 금창준, 김희정, 하인혁. 요추 추간판 탈출증 입원 환자 208례를 통한 한방치료의 효과 연구. 한방재활의학과학회지. 2013;23(1):77-86.
  42. 임세영, 유상민, 배경연, 이용현, 정재중. 요통환자에 대한 침치료와 물리치료의 단독 및 병행치료의 효과와 만족도 조사. 대한침구학회지. 2005;22(6):75-84.
  43. 장동호, 배우열, 정종훈, 이인선. 요통에 대한 추나요법과 가열식 화침 병행 치료의 효과. 한방재활의학과학회지. 2011;21(3):21-32.
  44. 장효길, 안순선, 허동석, 홍권의. 전열침이 장요인대 염좌로 인한 요통에 미치는 임상적 효과. 한방재활의학과학회지. 2010;20(3):109-17.
  45. 장혜정, 홍상민, 박유선, 남동우, 이두익, 이재동, 이윤호, 임사비나. 견비통의 한・양방 진료 및 협진의 경제성 평가. 대한침구학회지. 2007;28(1):72-86.
  46. Celik B, Er U, Simsek S, Altug T, Bavbek M. Effectiveness of lumbar zygapophysial joint blockage for low back pain. Turk Neurosurg. 2011;21(4):467-70.
  47. Shin JS, Ha IH, Lee TG, Choi YK, Park BY, Kim MR, Lee MS. Motion style acupuncture treatment (MSAT) for acute low back pain with severe disability: a multicenter, randomized, controlled trial protocol. BMC Complement Altern Med. 2011;11:127. https://doi.org/10.1186/1472-6882-11-127
  48. Skonnord T, Skjeie H, Brekke M, Grotle M, Lund I, Fetveit A. Acupuncture for acute non-specific low back pain: a protocol for a randomised, controlled multicentre intervention study in general practice--the Acuback Study. BMJ Open. 2012;2(3).
  49. Longo UG, Loppini M, Denaro L, Maffulli N, Denaro V. Rating scales for low back pain. Br Med Bull. 2010;94(1):81-144. https://doi.org/10.1093/bmb/ldp052