Perspectives on Integrative Medicine

Review Articles

The Safety and Effectiveness of Electroacupuncture for Labor Pain Relief: a Systematic Review and Meta-Analysis: Hyein Jeong, Jiwon Heo, Hyunsuk Park, Kyeong Han Kim; Perspect Integr Med. 2025;4(1):6-15. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.002

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Abstract PDF Supplementary Material: Background
Labor pain is among the most intense forms of pain, significantly impacting physical and psychological well-being. Although epidural anesthesia is effective, it has side effects and limited accessibility. Electroacupuncture (EA) offers a low-risk alternative. This systematic review and meta-analysis assessed the safety and effectiveness of EA in relieving labor pain and duration.
Methods
Randomized controlled trials comparing EA with standard treatments, including epidural anesthesia, were identified through database searches up to August 2024. The primary outcome was pain reduction (assessed using the visual analog scale), and the secondary outcomes were labor duration (1^st and 2^nd stages), Apgar scores, and adverse effects.
Results
In the analysis there were 10 randomized controlled trials (involving 1,498 women in labor) included in this review. EA statistically significantly improved both the level of pain and reduced labor duration compared with those women who received standard treatments (p < 0.001). Apgar scores were assessed in 3 studies and determined that the physical condition of the delivered babies was not statistically significantly different between EA and standard treatment for labor pain. Study protocol indicated the recording of adverse effects in one of the ten studies. Adverse events in that study recorded mild localized discomfort (1.89%, n = 1).
Conclusion
EA reduced labor pain and duration, and demonstrated its potential as an alternative to the conventional approaches for managing labor pain. The limited data suggest EA is likely safe, but further research is needed to confirm its safety profile.

Effects of Acupuncture on Cartilage Degradation and Joint Pain in Osteoarthritis: Jae-Hwan Jang, Jaejin Han, Changsu Na, Hi-Joon Park; Perspect Integr Med. 2024;3(3):134-141. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.002

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Graphical Abstract Abstract PDF: Osteoarthritis, resulting from joint decline, leads to various symptoms including joint pain, stiffness, tenderness, and local inflammation. These symptoms may be caused by the remodeling of the five structural phenotypes: inflammatory, subchondral bone, meniscal cartilage, atrophic, and hypertrophic phenotypes. Studies have shown that acupuncture can inhibit cartilage degradation by regulating extracellular matrix-degradation and enzyme synthesis. Notably, the efficacy of acupuncture treatment in osteoarthritis may be attributed to regulated inflammation and apoptosis of chondrocytes, as well as endogenous opioid production, and activation of the endocannabinoid systems (in the central and peripheral nervous systems), to contribute towards cartilage protection and joint pain relief. This review provides a current summary of the mechanisms of action of acupuncture in osteoarthritis, indicating that acupuncture, a therapy with fewer side effects than conventional medications, may be an effective treatment strategy for the management of osteoarthritis.

Original Articles

Effects of Pulsed Electromagnetic Field Therapy and Photontherapy in Cervicobrachialgia: A Randomized Controlled Trial: Bianca dos Santos Bobadilha, Talita Bonato de Almeida, Maria Imaculada de Lima Montebello, Maria da Luz Rosário de Sousa; Perspect Integr Med. 2024;3(1):37-44. Published online February 22, 2024; DOI: https://doi.org/10.56986/pim.2024.02.005

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Graphical Abstract Abstract PDF: Background
Cervicobrachialgia is a painful condition commonly treated with medication and physiotherapy. The aim was to evaluate pain following electromagnetic and photontherapy, and examine patient energy profiles.
Methods
There were 48 patients experiencing pain [Visual Analogue Scale (VAS) score ≥ 4] who were not receiving medication and physiotherapy and were randomized into Test Group (GT); electromagnetism using a Kenkobio device (intensity = 0.055 mT/frequency = 60 Hz) and photon therapy; a photon therapy blanket, and Placebo Group (GP); the Kenkobio device was turned off and the blanket was not used. Pain was assessed using the VAS, before, immediately after treatment, and the following day. Algometry was also carried out before and after the treatment to understand the pain threshold at bilateral acupoints GB20 and GB21. The energy profile was assessed using Ryodoraku measurements before and after the session.
Results
The GT achieved a greater reduction in pain the following day than GP. Both groups were equal for left GB20 and right GB21 points considering algometry and, after the intervention, a reduction in pain in the GT was noticed only in the left GB20 (CI [95%]: 0.09-0.99, p = 0.019). The average energy level was low and dropped further following treatment. Furthermore, energy from the Large Intestine Meridian tended towards balance in the GT compared with the GP [CI (95%): 0.58-15.75, p = 0.035]. No adverse effects were reported.
Conclusion
The combined use of electromagnetic and photontherapy were effective in reducing pain in patients and promoted energy rebalancing.

Structural and Criterion Validity of a New 6-item Roland–Morris Disability Questionnaire (RMDQ-6) on Patients with Chronic Lower Back Pain Receiving Integrative Medicine: Yoon Jae Lee, Gyu Chan Shim, Changsop Yang, Chang-Hyun Han; Perspect Integr Med. 2023;2(3):182-189. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.006

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Graphical Abstract Abstract PDF Supplementary Material: Background
Lower back pain (LBP) is a leading cause of disability worldwide. The Roland–Morris Disability Questionnaire (RMDQ) has been widely used to assess functional impairment in patients with LBP. However, its length and redundancy calls for a more concise and optimized version.
Methods
We conducted a secondary analysis of data from two randomized controlled trials comparing pharmacopuncture and physical therapy for chronic LBP. We focused on 132 patients with moderate-to-severe symptoms and analyzed their baseline data to evaluate the structural validity of the RMDQ. We used R packages lavaan and semPlot for confirmatory factor analysis (CFA). Model fit were assessed through various indices, including comparative fit index, Tucker–Lewis index, root mean square error of approximation, and standardized root mean squared residual.
Results
A total of 18 items were ultimately removed to produce a streamlined 6-item structure. Our model met the fit index criteria, yielding a one-domain, 6-item RMDQ structure. While the relative indices fell slightly short of the ideal values, the RMDQ-6 derived through CFA correlated well with the original version.
Conclusion
This study developed a more concise version of RMDQ through CFA to optimize its structural configuration. This concise instrument can be proposed as an efficient tool to assess the functionality of patients with LBP.

Review Article

Effectiveness and Safety of Low-Level Laser Treatment for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis: Sang Jun Lee, Seung Jin Noh, Jeong Rock Kim, Kyung Bok Park, Sae-rom Jeon, Yejin Hong, Dongwoo Nam; Perspect Integr Med. 2023;2(3):155-163. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.003

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Graphical Abstract Abstract PDF Supplementary Material: Background
Low-level laser treatment (LLLT) is used to treat low back pain (LBP) however, its effects on lumbar disc herniation (LDH) remain unclear. The safety and effectiveness of LLLT for LDH was determined using a systematic review of randomized clinical trials.
Methods
Studies on LLLT in adults with LDH were identified from 12 worldwide databases. A risk of bias assessment and a meta-analysis with categorization according to the type of control used (inactive, active, or add-on) was performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation.
Results
The quantitative analyses included five studies. LLLT was significantly more effective at treating LDH [leg pain visual analog scale (VAS) mean difference (MD): -1.90, 95% confidence interval (CI): -2.01, -1.80, I2 80%; LBP VAS MD: -0.79, 95% CI: -0.87, -0.71, I2 80%] than inactive controls (placebo or sham). The quality of the evidence ranged from “low” to “very low.” As an add-on to usual care, LLLT significantly improved pain intensity and disability compared with usual care (leg pain VAS MD: -2.52, 95% CI: -2.65, -2.40, I2 97%; LBP VAS MD: -1.47, 95% CI: -1.58, -1.36; Oswestry Disability Index MD: -4.10, 95% CI: -4.55, -3.65, I2 6%). However, the quality of the evidence ranged from “moderate” to “low.”
Conclusion
LLLT significantly improved outcomes compared with the inactive controls, but was not more effective than usual care for LDH. In combination with usual care, LLLT was significantly more effective than usual care alone highlighting the potential of LLLT.

Protocol

A Study Protocol for a Multicenter, Pragmatic, Randomized Controlled, Parallel-Grouped Pilot Clinical Trial: Effectiveness of Non-Pharmacological Versus Pharmacological Treatments for Non-Acute Lumbar Disc Herniation: Hui Yan Zhao, Purumea Jun, Chaewon Lee, In-Hyuk Ha, Chang-Hyun Han; Perspect Integr Med. 2023;2(1):59-64. Published online February 21, 2023; DOI: https://doi.org/10.56986/pim.2023.02.009

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Graphical Abstract Abstract PDF Supplementary Material

Background
This study was the development of a protocol for the comparison between the efficacy of non-pharmacological and pharmacological treatment approaches for lumbar disc herniation in a pragmatic environment to obtain real-world based study data.
Methods
The protocol sets out a two-armed, parallel, multicenter pragmatic, randomized-controlled trial (RCT) which will be conducted in four spine specialist hospitals in Korea to determine cost-efficiency.
Results
The study will enroll 36 participants and allocate patients into either the non-pharmacological treatment group or the pharmacological treatment group in a 1:2 ratio. Patients must have evidence of disc-related disease diagnosed using MRI, as well as having lower back pain or radiating leg pain (numeric rating scale score ≥ 5). The treatment will last for 8 weeks with a 26-week follow-up. The primary outcome will be measured using the Oswestry Disability Index score from Week 9. Secondary outcomes related to lower back pain and radiating leg pain will be measured using the scores from the numeric rating scale, the visual analogue scale, the European Quality of Life 5 Dimensions 5 Level Version), the 12-item Short Form Survey, and the patient global impression of change.
Conclusion
This is the first protocol for a pragmatic RCT evaluating the efficacy, safety, and cost-efficiency of non-pharmacological and pharmacological treatment strategies in a clinical setting. Following the basis of this protocol, RCTs may play an important role in establishing guidelines for treating radiating leg pain and lower back pain and provide effective information to clinicians in practical settings.

Citations

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Comparative Effectiveness of Non-Pharmacological and Pharmacological Treatments for Non-Acute Lumbar Disc Herniation: A Multicenter, Pragmatic, Randomized Controlled, Parallel-Grouped Pilot Study
Doori Kim, Jee Young Lee, Yoon Jae Lee, Chang Sop Yang, Chang-Hyun Han, In-Hyuk Ha
Journal of Clinical Medicine.2025; 14(4): 1204. CrossRef

Editorial

Integration of Acupuncture into UK Healthcare - A NICE Perspective: Why is Acupuncture Now Recommended for Chronic Pain but not for Back Pain or Osteoarthritis: Mike Cummings; Perspect Integr Med. 2023;2(1):3-7. Published online February 21, 2023; DOI: https://doi.org/10.56986/pim.2023.02.002

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2 Citations

Abstract PDF

In April 2021, the National Institute for Health and Care Excellence (NICE) published a guideline on chronic pain (NG193) with a recommendation to consider a single course of acupuncture treatment in patients with chronic primary pain. This positive recommendation came after the NICE guideline on low back pain and sciatica (NG59) announced in November 2016, that acupuncture treatment did not work for back pain, having previously recommended it in 2009 (CG88). This article attempts to explain this apparent contradiction in recommendations by tracing the history of acupuncture debates in the NICE guidelines over the last 2 decades.

Citations

Citations to this article as recorded by

Current status of health technology assessment in Korean medicine
Myeong Soo Lee, Hye Won Lee
Evidence-Based Chinese Medicine and Technology Ass.2025;[Epub] CrossRef
A Review of Key Research and Engagement in 2022
John McDonald, Sandro Graca, Claudia Citkovitz, Lisa Taylor-Swanson
Journal of Integrative and Complementary Medicine.2023; 29(8): 455. CrossRef

Review Articles

Effects of Acupuncture on Neuropathic Pain: Mechanisms in Animal Models: Jae-Hwan Jang, Hi-Joon Park; Perspect Integr Med. 2022;1(1):17-20. Published online September 22, 2022; DOI: https://doi.org/10.56986/pim.2022.09.004

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2 Citations

Abstract PDF

Neuropathic pain is a chronic condition/disease characterized by mechanical and thermal pain. Neuropathic pain can have various comorbidities such as depression, anxiety disorders and cognitive impairment, and as a result, can have a detrimental effect on quality of life. Pain and comorbid symptoms are often complicated, intertwined, affect each other, and present difficulties in treatment. Therefore, it is necessary to improve both pain and comorbid symptoms to treat neuropathic pain. Acupuncture is effective in treating not only pain but other conditions/diseases such as depression, anxiety, and cognitive impairment. Recently, acupuncture was reported to be effective in improving comorbid symptoms in patients with chronic pain. This review aimed to describe the mechanisms of action of acupuncture on the brain with respect to the improvement of comorbid symptoms that appeared in animal models of chronic neuropathic pain. Comorbidity-pain studies were comprehensively reviewed. Both manual acupuncture and electroacupuncture improved not only mechanical and thermal pain but also comorbid symptoms such as depression, anxiety, and cognitive impairment in patients with chronic neuropathic pain. The results of this review suggest that comorbid symptoms can be improved through various mechanisms, including the dopamine system in the brain, glutamate system, inflammation, epigenetic modulation, and mitochondrial function.

Citations

Citations to this article as recorded by

Long-term follow-up of inpatients with meniscus tears who received integrative Korean medicine treatment: A retrospective analysis and follow-up survey
June Haeng Lee, Jin Young Song, Kyoung Sun Park, Jinho Lee, In-Hyuk Ha, Yoon Jae Lee
Medicine.2024; 103(6): e36917. CrossRef
The analgesic effect of acupuncture in neuropathic pain: regulatory mechanisms of DNA methylation in the brain
Jae-Hwan Jang, Yoon Jae Lee, In-Hyuk Ha, Hi-Joon Park
PAIN Reports.2024; 9(6): e1200. CrossRef

Shoulder Pain and the Potential Role of Acupuncture: A Narrative Review of Clinical Practice and Treatment Guidelines: Stephen Birch, Myeong Soo Lee, Tae-Hun Kim, Terje Alraek; Perspect Integr Med. 2022;1(1):3-9. Published online September 22, 2022; DOI: https://doi.org/10.56986/pim.2022.09.002

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4 Citations

Abstract PDF Supplementary Material

The potential use of acupuncture for shoulder pain of various etiologies and whether clinicians make recommendations about the use of acupuncture was examined. Shoulder pain is a common clinical problem. What is the level of evidence and how often is acupuncture recommended for shoulder pain? A manual and database (PubMed) search of review articles of related clinical trials and guidelines was performed. The evidence for effectiveness of acupuncture treatment of different types of shoulder pain was weak. However, there are some studies, with a weak to moderate level of evidence, on shoulder pain (across nine subtypes of shoulder pain). Acupuncture is safe and may be a cost-effective treatment for shoulder pain. There were 131 statements recommending the use of acupuncture for shoulder pain across 12 subtypes of shoulder pain. The most common statements were for non-specific ‘shoulder pain.’ There were 11 statements against the use of acupuncture for shoulder pain and three subtypes of shoulder pain. The level of evidence in studies of acupuncture treatment for shoulder pain is low, therefore, further research is needed. Recommendations for the use of acupuncture for shoulder pain are increasing but lag behind those for other pain problems such as low back pain.

Citations

Citations to this article as recorded by

“Are we there yet?” – Green shoots of progress in acupuncture implementation in healthcare
Sandro Graca, Matthias Huemer, Beverley de Valois, Bobbee Vang, Lara McClure
European Journal of Integrative Medicine.2024; 69: 102371. CrossRef
Health Care Utilization for Common Shoulder Disorders: Analysis of the 2010–2019 National Patient Sample Data from the Health Insurance Review and Assessment Service in Korea
Jin-Young Kang, Doori Kim, Huijun Kim, In-Hyuk Ha, Yoon Jae Lee
Medicina.2024; 60(5): 744. CrossRef
Clinical effect analysis of timed strengthening moxibustion combined with continuing nursing on symptoms of qi deficiency and blood stasis type
Fang Liu, Xuan Wang, Man Zhao, Qing Qin
Medicine.2024; 103(52): e40886. CrossRef
A Review of Key Research and Engagement in 2022
John McDonald, Sandro Graca, Claudia Citkovitz, Lisa Taylor-Swanson
Journal of Integrative and Complementary Medicine.2023; 29(8): 455. CrossRef

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