Korean medicine use is associated with reduced lumbar surgery and opioid prescriptions in lumbar disc herniation: a nationwide cohort study.

INTRODUCTION: Lumbar disc herniation (LDH) is a common spinal disorder associated with chronic pain, reduced quality of life, and increased risk of lumbar surgery or long-term opioid use. Although Korean medicine treatments such as acupuncture and cupping have demonstrated effectiveness for LDH, the impact of their early intervention on surgical and opioid outcomes has not been examined at a population level. This study aimed to determine whether early Korean medicine (KM) treatment reduces the risk of lumbar surgery and opioid prescription in patients newly diagnosed with LDH compared to conventional medicine (CM) alone. METHODS: We conducted a nationwide, population-based retrospective cohort study using health insurance claims data from the Health Insurance Review and Assessment Service (HIRA) of South Korea. Patients with a primary diagnosis of lumbar and other intervertebral disc disorders with radiculopathy (ICD-10: M51.1) who initiated treatment between January 1 and December 31, 2015, were included. Of 788,505 eligible patients, 1:1 propensity score matching based on sex, age group, insurance type, and Charlson Comorbidity Index yielded a surgery dataset of 121,720 patients (KM: n = 60,860; CM: n = 60,860) and an opioid dataset of 72,684 patients (KM: n =36,342; CM: n =36,342), each followed for 4 years. Cox proportional hazards regression with sequential covariate adjustment was used to estimate hazard ratios for primary outcomes of lumbar surgery and opioid analgesic prescription. RESULTS: The KM group showed significantly lower risks of lumbar surgery (hazard ratio 0.801; 95% confidence interval, 0.762-0.842) and opioid prescription (hazard ratio 0.891 95% confidence interval, 0.844-0.940) compared to the CM group. CONCLUSION: These findings suggest that early KM intervention is associated with reduced rates of lumbar surgery and opioid use in LDH patients, supporting its role as an effective conservative treatment strategy.