1. Background and purpose
the 3rd Comprehensive Plan to Develop Korean Traditional Medicine (2016-2020) based on the Korean Medicine and Pharmaceutics Promotion Act states that its primary objective is ‘to strengthen evidence and enhance reliability through the development/dissemination of Korean Medicine Clinical Practice Guidelines,’ and to this aim, Korean Medicine Clinical Practice Guidelines were developed and disseminated: to further strengthen evidence and extend coverage of national health insurance for Korean Medicine medical services to increase accessibility to Korean Medicine for the general public.
Korean Medicine Clinical Practice Guidelines for neck pain were developed as part of this policy. Neck pain refers to pain of the neck area, namely pain in the anterior, posterior, and lateral regions of the neck.
the main characteristic symptoms of neck pain include pain in the neck region, pain aggravated upon movement, tender points within the affected area, and limited range of motion of the neck (limited flexion and extension, limited rotation and side bending), occasionally accompanied by pain radiating to the upper extremities.
In Korea, 1.3 million patients received outpatient consultations for neck pain in 2018 alone, and analysis of prevalence trends from 2014 to 2018 show that the number of patients is steadily increasing. Prevalence of neck pain patients continues to rise with the increased use of computers and smartphones, and neck pain is known for its tendency to recur and chronicitize after its initial onset occurrence. It also shows high prevalence in younger working populations, and is prone to incur work loss due to limitation in range of neck motion from pain. It can therefore be inferred that treatment and prevention are key factors in the management of neck pain.
the aim of this project was to analyze current evidence using an evidence-based approach for Korean Medicine treatment of neck pain, which is a condition for which many members of the general public utilize Korean Medicine treatment, using systematic review methodology, and thus develop a clinical practice guideline well-adapted to real-world Korean Medicine practice conditions based on the clinical and empirical experience of Korean Medicine clinicians. this clinical practice guideline was devised with the aim of aiding the decision-making process of clinical Korean Medicine doctors and patients within Korean Medicine practice conditions, and through the dissemination of the developed clinical practice guidelines,
it is further expected to provide neck pain patients with a means of receiving effective and standardized treatment. It is possible to enhance public health and quality of life through the appropriate use of standardized Korean Medicine treatment for neck pain. Ultimately, by means of enhancement of quality of Korean Medicine treatment, it is expected that the guideline will be able to contribute to heightening public awareness of the reliability of Korean Medicine and the achievement of the betterment of public health.
2. Overview of disease
Neck pain indicates pain occurring in the anterior, posterior, and lateral regions of the neck, and typical symptoms include pain, pain aggravated by movement, tender points of the affected area, limited range of motion of the neck, and pain radiating to the upper extremities. International prevalence has been reported from 14.2% to 71%, dffering according to various references. Neck pain takes 2nd place of the 20 highest ranking disorders incurring most Years Lived with Disability (YLD) due to disease or disorder according to the WHO. As neck pain most commonly occurs from ages 35 to 49, it is also known to greatly affect work loss.
While neck pain may be diagnosed by history taking, neurological examinations, and characteristics of symptoms, diagnostic imaging, and blood tests also need to be conducted as necessary. Major risk factors for neck pain include unhealthy lifestyles, and posture. Even after treatment, if the inappropriate lifestyle habits and posture persist and are not corrected, they may lead to recurrence or chronic pain and therefore warrant corrective education. Currently, high-frequency treatments for usual care of neck pain in conventional medicine include pharmacological treatment (analgesics), and such physiotherapy treatments as diathermy, electrotherapy, and traction therapy among non-pharmacological treatments. Of Korean Medicine treatments, according to a survey of Korean Medicine physicians regarding neck pain treatment, treatment modalities such as acupuncture, pharmacopuncture, herbal medicine, and Chuna manual medicine are the highest frequency Korean Medicine treatment techniques.
While some patients choose Korean medicine medical institutions as their fi rst option for neck pain, many opt to visit Korean medicine medical institutions after having visited conventional medicine medical institutions. It is common for patients to receive pharmacological treatment and physiotherapy after undergoing diagnostic imaging (generally X-rays) at conventional medicine medical institutions. Afterward, if such usual care is not as effective as the patient had initially anticipated, patients may choose to visit a Korean medicine medical institution from the anticipation of Korean Medicine, or from expectations that recovery would be accelerated from the use of integrative medicine treatment. Put again, neck pain patients receiving treatment may be largely divided into conventional medicine users (singular use), Korean medicine users (singular use), and integrative conventional and Korean medicine treatment users by choice of main treatment modality. this guideline was developed to address the needs of all such patients.
