An evidence-based approach for the development of a clinical practice guideline for the treatment of neck pain using traditional Korean medicine

Introduction: In Korea, all traditional Korean medicine interventions for neck pain are actively used, including acupuncture, herbal medicine, Chuna, and pharmacopuncture; however, clinical practice guidelines do not exist. We aimed to develop a clinical practice guideline for treating neck pain in adults using traditional Korean medicine.Methods: A committee comprising clinical and methodological experts was formed, and clinical questions were developed. A systematic review was conducted for each clinical question. The selected studies were analyzed and assigned a quality of evidence grade based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Recommendations were formulated considering the benefits and harms. A formal consensus was reached among the experts using the Delphi method. The final recommendations were recognized by relevant professional societies.Results: In total, 25 recommendations were developed regarding traditional Korean medicine treatments (acupuncture, electroacupuncture, fire needling, miniscalpel acupuncture, herbal medicine, Chuna manual therapy, pharmacopuncture, bee-venom pharmacopuncture, cupping, thread-embedding acupuncture, and Doin therapy). Acupuncture (versus inactive control) and Chuna manual therapy and pharmacopuncture (versus usual care) are recommended for symptom alleviation in the clinical treatment of neck pain. Electroacupuncture (versus usual care) and cupping (versus inactive control) should be considered for the alleviation of symptoms in the clinical treatment of neck pain.Conclusions: The guideline could assist traditional Korean medicine doctors in South Korea to provide evidence based, standardized treatment for neck pain in adults. Consequently, implementing this guideline in traditional Korean-medicine practice could expand the scope of health-insurance coverage, thereby reducing the public burden of medical expenses.