Discussion
Miniscalpel needle (MSN) therapy is a combination of traditional acupuncture theory and Western medical surgical treatment. It is a treatment strategy that treats chronic pain caused by adhesion of soft tissue through peeling, and provides smooth blood circulation and local recovery to the damaged tissue [
7]. It is used for several diseases, mainly for musculoskeletal diseases [
8-
12]. However, there are few studies examining the factors that affect prognosis, their correlation, and satisfaction of MSN for herniated intervertebral disc (HIVD) or spinal stenosis patients treated with MSN. Therefore, it is necessary to analyze the factors affecting prognosis and characteristics of patients treated with MSN for HIVD or spinal stenosis.
In this study, 95 patients who were admitted to the Dunsan Korean medicine hospital of Daejeon University from January 01, 2016 to September 30, 2017 were investigated for the treatment of herniated intervertebral disc or spinal stenosis with MSN. Demographic characteristics were assessed including gender, age, smoking history, drinking history, and occupation, and characteristics of disease, and disease duration, and therapeutic characteristics including number of MSN, Western medical treatment before or after MSN (injection or operation), discharge NRS, existence of current pain, current NRS, and existence of current treatment, and satisfaction characteristics including satisfaction of MSN, and intention of re-treatment with MSN.
Amongst the 6,511 patients admitted to Dunsan Korean medicine hospital of Daejeon University, 1,306 patients were admitted to the department of Acupuncture and Moxibustion. Patients treated with MSN for HIVD or spinal stenosis were selected, with uncontactable or dead patients excluded from the study. As a result, a total of 95 patients were investigated. There were 46 males (48.4%) and 49 females (51.6%), respectively. The mean age of patients was 53.55 years old and the largest group was patients in their 50’s (27 patients, 28.4%). Most of the patients were in their 40’s to 60’s, accounting for about 73.7% of the total. This finding seems to be similar to the results of studies where the herniated disc herniation mostly occurred in patients in their 30’s to 50’s and spinal stenosis in patients in their 50’s to 60’s [
15,
16].
The largest disease group was lumbar herniated disc (56 patients, 58.9%), followed by cervical herniated disc and lumbar spinal stenosis (17 patients each, 17.9%), so MSN was used most commonly for lumbar herniated disc. However, this may be due to the high rate of lumbar herniated disc among inpatients in Korean medicine hospital or Department of Acupuncture and Moxibustion [
1-
5]. Therefore, further research seems to be needed to determine the relationship between specific diseases and MSN.
Analysis of disease duration showed that the largest group of patients occurred in the chronic phase (57 patients, 60.0%), followed by subacute (23 patients, 24.2%), and acute phase (15 patients, 15.8%), so MSN was mainly used in chronic pain patients, which was probably linked to the high rate of chronic pain patients.
The results of investigation in therapeutic characteristics showed that the group treated only with MSN (38 patients, 40.0%) and the group treated with Western medicine before MSN (36 patients, 37.9%) accounted for the majority. The results from this study indicate that in patients treated with MSN, they will be less likely to receive Western medical treatment later, suggesting that MSN may be considered as an alternative to Western medical treatment as 1 of the conservative treatment strategies of Korean Medicine.
The results of investigation in satisfaction characteristics showed that patients were mostly satisfied with MSN. Further studies on the satisfaction of MSN through survey with additional items such as reason for responding with satisfaction or dissatisfaction, or requirements for improvement are needed.
Crossover analysis using the Chi-square test, Independent t test, one-way ANOVA, multiple linear regression analysis, and binary logistic regression analysis were conducted to analyze the relationship between each characteristic. Crossover analysis was conducted to investigate the relationship between categorical variables such as gender, age, smoking history, drinking history, occupation, disease, disease duration, treatment method, existence of current pain, existence of current treatment, satisfaction of MSN, and intention of re-treatment with MSN. Independent t test and one-way ANOVA were conducted to determine the relationship between categorical variables such as gender, age, smoking history, drinking history, occupation, disease, disease duration, and treatment methods and continuous variables such as discharge NRS, current NRS, difference between discharge and current NRS, and number of MSN. Multiple linear regression analysis was conducted to investigate the variables affecting continuous variables such as discharge NRS, current NRS, difference between discharge and current NRS, and satisfaction of MSN. Binary logistic regression analysis was conducted to determine the variables affecting the binary categorical variables such as existence of current pain, existence of current treatment, and intention of re-treatment with MSN.
The results of the crossover analysis using the Chi-square test showed that there was a difference in the treatment methods according to gender. There was a greater proportion of females belonging to the group that received Western medical treatment only before MSN (22 patients, 44.9%) than males (14 patients, 30.4%). In contrast, more males, were in the group who received Western medical treatment both before and after MSN (8 patients, 17.4%) than females (1 patient, 2.0%). In other words, males tended to receive more Western medical treatment after MSN than females.
In addition, there was a difference in the incidence of patients experiencing current pain according to their disease duration group. The percentage of patients who had current pain among patients treated with MSN in acute phase (13 patients, 86.6%) was higher than that of the subacute (11 patients, 47.8%) and chronic phase (45 patients, 78.9%). Therefore, it seems to be more efficient to treat with MSN in the chronic phase rather than in the acute phase. In the acute phase, it is considered more effective to administer treatments other than MSN.
There were differences in the satisfaction and intention of re-treatment with MSN according to disease duration, and treatment methods. The percentage of patients who answered as neutral in the chronic phase group (29 patients, 50.9%) was higher than that in the acute (2 patients, 13.3%) and subacute phase groups (4 patients, 17.4%). Considering that patients in the chronic phase group (57 patients, 60.0%) showed the highest number of patients treated with MSN, improving the satisfaction of the patients in the chronic phase group should be considered. The percentage of patients who were somewhat satisfied in the group treated with MSN only (14 patients, 36.8%), was higher than that of others, and the percentage of patients who were somewhat dissatisfied in the group who received Western medical treatment both before and after MSN (5 patients, 55.6%) was higher than that of others. Furthermore, the percentage of patients who did not have intention of re-treatment with MSN in the group that received Western medical treatment both before and after MSN (7 patients, 77.8%) was higher than that of others. The percentage of patients who had intention of re-treatment with MSN in the groups who received Western medical treatment only before MSN (24 patients, 66.7%) and only treated with MSN (24 patients, 63.2%), were higher than that of others. In other words, it seems that minimizing Western medical treatment and applying MSN treatment has a beneficial effect, and therefore satisfaction and intention of re-treatment with MSN are also improved.
The results of the Independent t test and one-way ANOVA showed there was a difference in the current NRS according to disease duration. The mean of current NRS in the chronic phase group (3.86), was higher than that of the subacute phase (2.00). Therefore, if the MSN is administered in the subacute phase, it may reduce pain in the future and prevent progression to chronic phase.
In addition, there was a difference between discharge and current NRS according to disease 3. The mean difference between discharge and current NRS in the spinal stenosis group (3.14) was higher than that in the herniated disc group (1.60). Therefore, among patients treated with MSN, patients with spinal stenosis showed a greater decrease in current pain compared to pain upon discharge than in patients with a herniated disc. However, this is a consequence of other unconsidered factors, so further studies on the relationship between disease and NRS reduction are needed.
There were differences in the number of MSN according to disease 1 and 2. The mean number of MSN in the cervical disease group (7.91) was higher than that in the lumbar disease group (5.16), and the mean of number of MSN in the cervical herniated disc group (8.53) was higher than that in the lumbar herniated disc group (4.43). Based on this data, it would be more efficient to explain to patients the characteristics of the treatment region before performing MSN, and it could be used for the calculation of the number of MSN according to disease and region.
The results of the multiple linear regression analysis indicated that as the age, and disease duration increased by 1 unit, the discharge NRS increased each by 0.047 and 0.845, and as the number of MSN increased by 1 unit, the discharge NRS decreased by 0.127. As the disease duration increased by 1 unit, the current NRS increased by 0.677, and as the number of MSN increased by 1 unit, the current NRS decreased by 0.162. Furthermore, the more the patients did not receive Western medical treatment after MSN, the more satisfied the patients were with MSN treatment, and as the discharge NRS and current NRS increased by 1 unit, the satisfaction of MSN decreased by 0.099. In other words, the longer the disease duration, the fewer the number of MSN and greater discharge and current NRS. Furthermore, as the discharge and current NRS increases, the satisfaction of MSN decreases. Therefore, it is suggested that maximizing the number of MSN treatments within the appropriate range before chronic development of the disease, helps to reduce the pain immediately after treatment. In the future, this may increase satisfaction with MSN treatment.
The results of the binary logistic regression analysis showed that when discharge NRS increased by 1 unit, the odds ratio of current pain increased by 1.299 times. When compared with male patients, the odds ratio of intention of re-treatment with MSN in female patients decreased by 0.246 times, and as the discharge NRS increased by 1 unit, the odds ratio of intention of re-treatment with MSN decreased by 0.715 times. When compared with Western medical treatment both before and after MSN, the odds ratio of intention of re-treatment with MSN in groups treated with MSN only or treated with Western medicine only before MSN, increased by 31.333 times and 42.036 times, respectively. Therefore, in order to increase the patients motivation for re-treatment with MSN, it is important to reduce the discharge NRS through aggressive Korean medical treatment as well as MSN during admission. Female patients may be relatively more sensitive to the pain felt during MSN, so the motivation for re-treatment with MSN seems to be less than in males. Moreover, as confirmed in the crossover analysis, it seems that this data can be used to increase the effectiveness of MSN, minimizing Western medical treatment, and increasing the motivation for re-treatment with MSN in groups treated only with MSN and treated with Western medicine only before MSN, which is relatively higher than other groups.
This study was performed on patients who were admitted to Dunsan Korean medicine hospital of Daejeon University from January 01, 2016 to September 30, 2017, for the treatment of herniated disc or spinal stenosis with MSN, and the purpose of this study was to evaluate the characteristics, prognosis, current status of patients, variables affecting prognosis, and their relationship through retrospective statistical analysis. This study is meaningful in prognostic analysis of large-scale participants for MSN and statistical analysis of variables affecting the prognosis and satisfaction. It can be used as the basis for treatment with MSN, patient consultation related to MSN, and development of standardized MSN medical treatment guidelines. However, this study has some limitations. This is a retrospective study based on data collected on medical records and patient statements rather than a prospective study designed using control groups. Detailed treatment methods such as other Korean medical treatments apart from MSN were not controlled. Further studies of multicenter, large-scale prospective randomized control with long-term, systematic observations are needed.
Conclusion
Demographic characteristics, disease characteristics, therapeutic characteristics, and satisfaction characteristics were investigated in patients who were admitted to Dunsan Korean medicine hospital of Daejeon University from January 01, 2016 to September 30, 2017, for the treatment of herniated disc or spinal stenosis with MSN, and analyzed statistically. The results were as follows.
• As a result of the crossover analysis using the Chi-square test, there were differences in the treatment methods according to gender, current pain according to disease duration, satisfaction of MSN according to disease duration, and intention of re-treatment with MSN according to treatment methods.
• As a result of the Independent t test and one-way ANOVA, there was a difference in the current NRS according to disease duration, between discharge and current NRS, and the number of MSN according to disease.
• As a result of the multiple linear regression analysis, the independent variables statistically affecting discharge NRS were age, disease duration, and number of MSN, affecting current NRS were disease duration, and number of MSN, and affecting satisfaction of MSN were Western medical treatment after MSN, discharge NRS, and current NRS.
• As a result of the binary logistic regression analysis, the independent variable statistically affecting current pain was discharge NRS, and affecting intention of re-treatment with MSN were gender, discharge NRS, and treatment methods.