P-072 - (Poster #72) Clinical Outcomes and Associated Factors of Korean Medicine Inpatient Care for Acute Neck and Low Back Pain Following Traffic Accidents : A Retrospective Chart Review

Background: Traffic accidents are a leading cause of acute musculoskeletal injuries, often resulting in neck and low back pain. Korean Medicine (KM) is commonly used to treat such injuries, but limited evidence exists regarding its effectiveness and safety in real-world inpatient settings. Additionally, psychosomatic factors such as anxiety, depression, fatigue, and sleep disturbances are increasingly recognized as influential in pain perception and recovery, yet their role in KM treatment has been insufficiently explored. Real-world patients often experience pain in multiple regions rather than in isolated areas, and are treated with integrative KM approaches combining acupuncture, herbal medicine, pharmacopuncture, cupping, and manual therapy. This discrepancy between clinical complexity and the design of previous studies highlights the need for more comprehensive evaluations. Investigating both clinical and psychosomatic outcomes within a KM inpatient context may provide a more holistic understanding of treatment effectiveness and inform better pain management strategies for patients recovering from traffic accidents.

Purpose/Objectives: This study aimed to evaluate the clinical outcomes and safety of Korean Medicine (KM) inpatient care in individuals experiencing acute neck or low back pain resulting from traffic accidents. In particular, it assessed the relationship between psychosomatic factors including anxiety, depression, fatigue, and insomnia, and pain-related outcomes observed during hospitalization. By incorporating a range of clinical and patient-reported measures, the study sought to generate real-world evidence regarding the effectiveness of integrative KM interventions. Moreover, it aimed to explore whether simultaneous management of both physical symptoms and psychological distress could enhance overall recovery. The findings were intended to inform clinical practice by highlighting the potential value of integrative KM approaches in addressing the complex needs of patients recovering from musculoskeletal trauma.

Methods: A retrospective chart review was conducted using clinical data from 190 patients hospitalized for 2 to 28 days at Kyung Hee University Korean Medicine Hospital between 2018 and 2023. All patients presented with acute neck or low back pain following traffic accidents and received integrative Korean Medicine treatments, including acupuncture, electroacupuncture, pharmacopuncture, herbal medicine, cupping, and Chuna therapy tailored to individual symptoms.
Pain intensity was assessed using the Numeric Rating Scale (NRS), and axial pain was operationally defined as the higher of the two scores for neck or low back pain. Additional outcomes included the Neck Disability Index, Oswestry Disability Index, and psychosomatic measures such as depression (PHQ-9), anxiety (BAI), insomnia (ISI), fatigue (FSS), and EQ-5D, evaluated at both admission and discharge.
To evaluate treatment effectiveness, paired t-tests were used to compare pre- and post-treatment scores, including pain intensity and psychosomatic outcomes. Pearson correlation and univariable linear regression were used to examine associations between baseline psychosomatic variables and initial pain severity. To assess the relationship between changes in psychosomatic symptoms and pain reduction at discharge, multivariable linear regression models were applied with progressively adjusted covariates. Treatment safety was reviewed based on blood chemistry and medical records.

Results:

Paired t-tests showed significant reductions in pain intensity following integrative Korean Medicine inpatient care. Numeric Rating Scale (NRS) scores decreased by 2.09±1.84 for axial pain, 2.21±1.82 for neck pain, and 1.94±1.78 for low back pain (all p< 0.05). Functional outcomes also improved, with the Neck Disability Index (NDI) and EuroQol five-dimensional questionnaire (EQ-5D) scores showing statistically significant changes from admission to discharge. Among psychosomatic indicators, Patient Health Questionnaire-9 (PHQ-9) scores showed significant pre-post reduction, while Beck Anxiety Inventory (BAI), Insomnia Severity Index (ISI), and Fatigue Severity Scale (FSS) scores did not show statistically significant differences in paired comparisons.
Pearson correlation and univariable linear regression analyses indicated that higher baseline PHQ-9 and ISI scores were associated with higher pain intensity at admission. Univariable analyses for predictors of pain at discharge showed that greater improvements in PHQ-9, BAI, and FSS scores, as well as longer hospitalization duration, were significantly associated with lower NRS scores at the end of the treatment period.
In multivariable linear regression models, reductions in PHQ-9, BAI, and FSS scores remained significantly associated with lower discharge NRS scores, especially for axial and low back pain. ISI improvement also reached statistical significance after adjusting for demographic and clinical covariates including sex, age, height, weight, body mass index (BMI), presence of medical history, use of medications, number of chief complaints, and duration from symptom onset to hospitalization. For neck pain, change in PHQ-9 was the only psychosomatic variable that remained significantly associated with pain improvement.
Safety evaluation based on blood chemistry profiles showed that liver enzymes (AST, ALT), renal function markers (BUN, creatinine), alkaline phosphatase (ALP), and total bilirubin levels remained within normal reference ranges throughout hospitalization. No serious adverse events, such as allergic reactions, infections, or systemic complications, were identified in the medical records during the inpatient period.

Conclusions/Implications for future research and/or clinical care:

This study evaluated the effectiveness and safety of Korean Medicine inpatient care for acute musculoskeletal pain after traffic accidents. Pain and functional outcomes improved, and psychosomatic symptom reduction was associated with pain relief. Longer hospitalization was related to greater improvement, suggesting that adequate treatment duration may aid recovery.
Improvements in depression, anxiety, and fatigue remained significantly linked to reduced pain at discharge even after adjusting for clinical and demographic factors. Although baseline psychosomatic distress was not a strong predictor of discharge pain, changes during hospitalization were consistently associated with outcomes, especially in low back pain.
The integrative Korean Medicine treatments used in this study reflected real-world practice and included comprehensive interventions tailored to individual symptom profiles. Safety outcomes based on lab tests and medical records indicated no serious adverse events and stable liver and kidney function parameters.
Although the retrospective design limits causal interpretation, the inclusion of both physical and psychosomatic measures provides useful insights into recovery. These findings may guide clinicians in developing more comprehensive care strategies and support the role of Korean Medicine in managing complex post-traumatic pain. Future prospective studies with standardized protocols and control groups are needed to validate these observations.