Journal of Alternative Complementary & Integrative Medicine Category: Medicine Type: Research Article

Interventions of Traditional Korean Medicine for Chronic Pelvic Pain: A Literature Review of Case Studies

Soo-Hyun Sung1, Angela-Dong-Min Sung1, Ji-Hye Yeon2, Jang-Kyung Park3, Won-Choon Jung4, Tae-Young Jung5 and Jong-Hyun Park4*
1 Deptment Of Traditional Korean Medicine Policy, National Development Institute For Korean Medicine, Korea, Democratic People's Republic Of
2 Sonamoo Traditional Korean Medicine Clinic, Korea, Democratic People's Republic Of
3 Deptment Of Korean Ob And Gy, School Of Korean Medicine, Pusan National University, Korea, Democratic People's Republic Of
4 Deptment Of Pathology, College Of Korean Medicine, Dae-Gu Haany University, Korea, Democratic People's Republic Of
5 Deptment Of Diagnostics, College Of Korean Medicine, Dae-Gu Haany University, Korea, Democratic People's Republic Of

*Corresponding Author(s):
Jong-Hyun Park
Deptment Of Pathology, College Of Korean Medicine, Dae-Gu Haany University, Korea, Democratic People's Republic Of
Tel:+82 538191827,
Fax:+82 538191850
Email:moguri@dhu.ac.kr

Received Date: Feb 13, 2020
Accepted Date: Feb 24, 2020
Published Date: Feb 28, 2020

Abstract

Objectives: The aim of this study is to review case studies on interventions of Traditional Korean Medicine (TKM) for Chronic Pelvic Pain (CPP). 

Methods: We searched eleven electronic databases for relevant studies up to Apr 2018. Case studies of Case studies of TKM treatments for CPP were included and analyzed. 

Results: 12 case studies were included and total number of patients of the experimental group was 91 cases. A total of 9 intervention methods were used, of which acupuncture was of the highest number, used in 11 studies (91.7%), followed by herb medicine in 10 studies (83.3%), moxibustion in 8 studies (66.7%), pharmacopuncture in 3 studies (25.0%) and steam therapy in 2 (16.7%). SP6 (90.9%), LI4 (54.5%) and PC6 (54.5%), were frequently used acupuncture point in acupuncture treatment. 

Conclusion: TKM treatment such as acupuncture, moxibustion, herbal medicine seems to be an effective treatment in patients with CPP. High-quality RCT is needed in order to make decisions on whether TM treatments should be used for treating CPP.

Keywords

Case studies; Chronic Pelvic Pain; Literature Review; Traditional Korean Medicine

INTRODUCTION

Chronic Pelvic Pain (CPP) refers to a condition in which local bodily pain, of which the cause cannot be identified, non-periodically continues at the pelvis, frontal abdominal wall, lumbar, hip for more than six months [1,2]. CPP can be caused by infection, inflammation, neuropathic pain, fibromyalgia, myoma uteri, endometriosis, prostatitis, or unknown causes [3]. 

Ahangari conducted a systematic literature review on the prevalence of CPP among women [4]. With seven articles out of the 140 articles published on CPP from 2005 till 2012, it was reported that the prevalence of CPP among women was between 6% and 27%. Roberts reported in his cohort study on 2,115 American men between 40 and 79 that about 9% of the patients were diagnosed with prostatitis/CCP by a doctor [5]. 

In the textbooks of Oriental medicines, CPP falls into the category of dysmenorrhea (??????), pain due to qi stagnation for a long time(??? ????), Pain before and after mestruation (?????) and lower abdominal pain (???) and is closely related to the factors of internal medicine, OBGY, urology, musculoskeletal system and psychiatric/neural factors [6-8]. Six evils (??), seven passions (??), foods (??), the tirednesss (??), injuries (??), insect bite (???) or the insufficiency in essence (?), qi (?), or blood (?) may result in the pain by disturbing the flow of energy and blood (??) in organs or the Gyeongrak of the body [9]. The treatment is optimized according to the symptoms of the patients. The key treatment elements are composed of acupuncture, moxibustion, or Traditional Medicine (TM), considering the medical history, mental elements and living environment of the patient [2]. 

Western medicine treats this disease with paracetamol, NSAIDs, antidepressants, anticonvulsants, gabapentin, or nerve blocks [3]. In the case of paracetamol, while the medicine is effective in the alleviation of fever or pain, if the medicine hits the spot, there is no evidence to support the use of this medicine on CPP [3]. As for NSAIDs, they are effective when the disease is related to pain, inflammation or peripheral nervous system and therefore used to treat ordinary CPP. However, these medicines are known for severe side effects [3]. Antidepressants, anticonvulsants, or gabapentin are effective in neuropathic pain. However, there is no effect on CPP with other causes [3]. Nerve blocks are effective in treating CPP. However, the diagnosis and treatment using this method must be given by a trained expert, and there is a chance of side effects, as well [3]. 

Sung conducted a meta-analysis and systematic review on the effect of acupuncture treatment on female CPP patients [10]. Carinci conducted a systematic literature review on the effect of alternative treatments, including acupuncture, herbal medicine, mind/body medicine and massage therapy [11]. However, there has not been a study that summarized the overall trends in the treatment of CPP, covering Traditional Korean Treatment (TKM) (e.g., acupuncture, electroacupuncture, pharmacopuncture, moxibustion, herb medicine, cupping, chuna and qigong). 

Therefore, the researchers gathered and analyzed the case studies on the TKM treatment of CPP. The purpose of this study is to provide a guideline for the TM of CPP that could be utilized in clinical contexts.

METHOD

Data Sources and Searches

As for the English databases, the researchers searched Pubmed, Medline, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL Plus, totaling to five websites. As for the Korean databases, the researchers searched the Korea Institute of Science and Technology Information (KISTI), Korean Traditional Knowledge Portal, KoreaMed, Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS) and National Library of Korea, totaling to six websites. The searches were all conducted in April 2018 and there were no limitations in the periods and languages. 

The search keyword was “chronic pelvic pain OR chronic pelycalgia OR chronic pain of pelvic OR chronic pelvic ache” AND “acupuncture OR electroacupuncture OR pharmacopuncture OR moxibustion OR herb medicine OR herb OR cupping OR Korean medicine OR oriental medicine OR chuna OR qigong” AND “clinical Studies OR case studies OR case series OR case report OR case controlled trial OR randomized controlled trial OR cohort studies (Table 1)”.

 

keyword

#1.

chronic pelvic pain OR chronic pelycalgia OR

chronic pain of pelvic OR chronic pelvic ache

#2.

acupuncture OR electroacupuncture OR pharmacopuncture OR

moxibustion OR herb medicine OR herb OR cupping OR

korean medicine OR oriental medicine OR chuna OR qigong

#3.

case studies OR case series OR case report

#4.

#1 AND #2 AND #3

Table 1: Search Strategy for Databates.

Inclusion criteria

In this study, the studies on TKM treatment (e.g., acupuncture, electroacupuncture, herb medicine, pharmacopuncture, cupping, moxibustion and chuna etc.) upon patients of CPP were included. There were no limitations in the genders or ages of the patients. Also, there were no limitations with regard to the intervention methods used on the control groups in controlled studies or randomized and controlled studies.

Exclusion criteria

Reviews, experimental studies, surveys, or other studies that were not clinical trials were not included in our analyses. Clinical studies that were not conducted upon the patients of CPP were also excluded. Also, studies based on western medicine, surgeries or clinical studies that were not case studies were also excluded.

Study selection and data extraction

The researchers check the titles and abstracts of the studies in the search results to identify the studies that satisfied the inclusion criteria. The analyses were conducted after extracting the information such as the author, year, diagnosis name, number of patients, treatment period, treatment, traditional Korean medicine pattern, outcome, and results.

RESULTS

Study selection and description

Our search generated a total of 82 potentially relevant studies, finally, 12 case studies (English databases: n = 1; Korean databases: n=11) met our inclusion criteria (Figure 1).

Figure 1: Flowchart of Study Selection Process. CPP: Chronic Pelvic Pain; RCTs: Randomized Clinical Trials, TKM: Traditional Korean Medicine.

12 case studies on CPP can be summarized in terms of their authors, year, diagnosis name, the number of patients, treatment period, treatment, traditional Korean medicine pattern, outcomes and results as shown in table 2 (A & B). 

First author,

Year

Patient(s),

number of cases

Treatment

period

Intervention

Traditional Korean (Chinese)

medicine pattern

Outcome

measurements

Main Result

Acupuncture

Herbal medicine

moxibustion

Etc.

Kang [12]

CPP patient with chronic pelvic inflammatory disease,

n=1

13 days

ST36, LR3,

SP4, SP6,

HT7, HT8,

SP2, LR2,

LR1, SP1,

CV13, CV12,

CV10, ST25,

LI11, LI4,

EX-HN5,

ST8, BL2,

GV20

1. Seonghyangjeonggi-san

2. Gamisoyosan-gami

CV12, CV4,

BL23 BL17

1. Suggestive

therapy

2. Relaxation

therapy

3. Retention enema

1. Qi stagnation-blood

stasis

2. Liver-spleen

disharmony

1. VAS

1. Improved

Rim [13]

CPP patient after treated with Western medication and surgery, n=56

5 weeks

-

-

-

1. Pharmacopuncture

n.r.

1. TER for CPP

1. Improved

Yi [14]

CPP patient with ovarian cyst, n=1

4 weeks

LI4, LR3,

PC6, SP6

1. Saenghwa-tang

2. Banchong-san

CV4, CV12

-

1. Blood-stasis

1. VAS

1. Improved

Yu [15]

CPP patient with adenomyosis, n=1

7 weeks

SP6, SP9,

ST36, LI4,

LR3, CV2,

CV3, CV4,

ST28, KI19,

BL31, BL32,

BL33, BL34,

GB30, BL40,

LI4

1. Banchongsan-gami

2. Gwibi-tang+Gyoaesamul

-tang

3. Gwibitang

4. Yikwiseungyang-tang

CV3 CV4

-

1. Deficiency and cold

1. VAS

2. Symptom changes

1. Improved

2. Improved

Youn [16]

CPP patient with chronic prostatitis,

n=15

2 weeks to

8 weeks

GV20, PC6,

KI6, SP9,

SP6, ST25,

CV4, CV2

1. Indongsoyeom-bang

CV6, CV4,

CV12

-

n.r.

1. NIH-CPSI

2. IPSS

3. EPS

1. Improved

2. Improved

3. Improved

Ohlsen [17]

CPP patient with chronic prostatitis,

n=1

8 weeks

KI7, SP10,

SP6, SP9,

CV3, PC6, LI11, LI12,

ST36, BL18,

BL23, BL28

LR5

1. Paljung-san

2. Ilguan-jeon

-

-

1. Yin deficiency of the

liver and kidney

2. Qi stagnation

1. NIH-CPSI

1. Improved

Lee [18]

CPP patient with chronic prostatitis,

n=1

4 weeks

Ouch point

-

CV4, CV2

-

n.r.

1. NIH-CPSI

2. IPSS

3. VAS

1. Improved

2. Improved

3. Improved

Kim [19]

CPP patient with endometriosis(2 cases)

or ovarian cyst(1 case)or adenomyosis(3 cases),

n=6

6 days to 20 days

GB41, SI3,

BL66, SI2,

SP6, SP8,

SP9, CV6,

CV4, CV8,

CV3

(2 cases-endometriosis)

1. Banchongsan-gami

2. Yijinsamultang-gami

(1 cases-ovarian cyst)

1. Banchongsan-gami

2. Yikwiseungyang-tang

(3 cases-adenomyosis)

1. Banchongsan-gami

2. Palmul-tang+Ganghwang-san

3. Gunggwijohyeoreum-gami

4. Yijinsamultang-gami

5. Bojungikgitang-gami

(2 cases)

CV3, CV4,

CV8, CV12,

SP6

(1 cases)

CV4, CV12

(3 cases)

CV3, CV4,

CV6, CV12,

ST25, SP6

(2 cases)

-

(1 cases)

-

(3 cases)

1. Steam therapy

(2 cases)

1. Qi stagnation

2. Yin and blood deficiency

(1 cases)

1. Cold hernia

2. Qi deficiency

(3 cases)

1. Qi stagnation

2. blood stasis and deficiency

3. Qi deficiency

1. VAS

1. Improved

Kim [20]

CPP patient with chronic prostatitis,

n=1

6 weeks

LI4, PC6,

LI11, LR3,

SP6, ST36,

CV13, CV12,

CV10, CV24,

GV20

1. Simmidojeok-san

-

1. Pharmacopuncture

1. Small intersine excess heat syndrome

1. NRS

2. NIH-CPSI

1. Improved

2. Improved

Kim [21]

CPP patient with endometriosis, n=1

21 weeks

CV12, ST25,

CV4, CV3,

EX-CA1,

LI4, LR3,

PC6, TE5,

ST36, SP6

1. Jogyeongjongoktang-gami

CV12, ST25,

CV3

-

1. Qi stagnation

2. Deficiency of qi and blood

3. Blood stasis

1. TSD

2. EHP-5

1. Improved

2. Improved

Park [22]

CPP patient with hematuria,  n=1

20 days

CV3, CV4,

CV6, CV12,

SP6, SP7,

SP9, LR1,

LR2, PC6,

ouch point,

yeong-gol,

dae-baeg

1. Samultang-gagam

2. Banchongsan-gagam

CV12, CV4,

ST25

1. Cupping

2. Steam therapy

1. Blood deficiency

2. Blood heat

1. Urine test

2. HGS

3. NRS

1. Improved

2. Improved

3. Improved

Yu [23]

CPP patient with chronic prostatitis,

n=6

76 days to

184 days

LU8, KI7,

SP3, KI3

1. Sibimijihwangtang-gagam

-

1. Pharmacopuncture

1. Kidney deficiency

1. NIH-CPSI

1. Improved

Table 2A: Characteristics of Published Case Studies of Chronic Pelvic Pain.

Intervention

Number of Papers

N (%)

Acupuncture

11 (91.7)

Herbal Medicine

10 (83.3)

Moxibustion

8 (66.7)

Pharmacopuncture

3 (25.0)

Steam Therapy

2 (16.7)

Table 2B: Interventions Reported in Case Studies of Chronic Pelvic Pain.

The number of studies and patients by years

As for the number of case studies on CPP, the first was published in 2001, while 2015 saw the largest number of publications, which was 3. A total of 12 case studies were published, with the total number of patients being 91 (Figure 2).

Figure 2: Studies and Case of Cases Studies of Chronic Pelvic Pain by Years.

Categorization by the intervention methods

A total of 12 case studies on CPP used a total of 9 intervention methods. There were 4 intervention methods that were used in two or more studies, of which acupuncture was of the highest number, used in 11 studies (91.7%), followed by herb medicine in 10 studies (83.3%), moxibustion in 8 studies (66.7%), pharmacopuncture in 3 studies (25.0%), and steam therapy in 2 (16.7%).

Categorization by acupuncture points

Among the 12 case studies, 11 used a total of 58 different acupuncture points. Of these, nine acupuncture points that were used in 4 or more studies. These were, respectively; SP6 (???), being used in 10, which was the highest in number; (90.9%), LI4 (??) and PC6 (??), respectively being used in 6 studies (54.5%); CV3 (??), CV4 (??), LR3 (??), SP9 (??) and ST36 (???), respectively being used in 5 studies (45.5%); and CV12 ??) being used in 4 studies (46.4%) (Table 3). Ouch points (???) were not considered as an acupuncture point.

Acupuncture Point

Chinese Name

Number of Papers

n(%)

SP6

???

10 (90.9)

LI4

??

6 (54.5)

PC6

??

6 (54.5)

CV3

??

5 (45.5)

CV4

??

5 (45.5)

LR3

??

5 (45.5)

SP9

???

5 (45.5)

ST36

???

5 (45.5)

CV12

??

4 (36.4)

Table 3: Acupuncture Point of Case Studies of Chronic Pelvic Pain.

The classification of the acupuncture point by diseases: Table 4 shows the results of the classification of the acupuncture points used in 11 out of 12 case studies of CPP. The classification was made focusing on the diseases that were mentioned in two or more studies. Kim used the same acupuncture points for the patients of CPP with three different diseases [19].

Types of Patient’s Diseases

(Number of Case Studies)

Acupuncture

Point

Chinese Name

Number of Papers

n(%)

Chronic Prostatitis

(n=5)

PC6

??

3 (60.0)

SP6

???

3 (60.0)

GV20

??

2 (40.0)

KI7

??

2 (40.0)

LI11

??

2 (40.0)

SP9

???

2 (40.0)

ST36

???

2 (40.0)

Endometriosis

(n=2)

CV3

??

2 (100.0)

CV4

??

2 (100.0)

SP6

???

2 (100.0)

Adenomyosis

(n=2)

CV3

??

2 (100.0)

CV4

??

2 (100.0)

SP6

???

2 (100.0)

Ovarian Cyst

(n=2)

SP6

???

2 (100.0)

Table 4: Acupuncture Point of Case Studies according to Patient’s Diseases.

Classification by the herb medicines

Of the 12 case studies, 10 used a total of 17 different herb medicines. 

Classification of the herb medicines by diseases: Table 5 shows the result of the classification of the herb medicines used in 10 studies out of the total 12 case studies by their diseases.

Types of Patient’s Diseases

(Number of Case Studies)

Herbal Medicine

Number of Papers

n(%)

Chronic Prostatitis

(n=4)

Indongsoyeom-bang (?????)

1 (25.0)

Paljung-san (???)

1 (25.0)

Ilguan-jeon (???)

1 (25.0)

Simmidojeok-san (?????)

1 (25.0)

Sibimijihwangtang-gagam (??????-??)

1 (25.0)

Endometriosis

(n=2)

Jogyeongjongoktang-gami (?????-??)

1 (50.0)

Banchongsan-gami (???-??)

1 (50.0)

Yijinsamultang-gami (?????-??)

1 (50.0)

Adenomyosis

(n=2)

Banchongsan-gami (???-??)

2 (100.0)

Gwibi-tang+Gyoaesamul-tang (???+?????)

1 (50.0)

Gwibitang (???)

1 (50.0)

Yikwiseungyang-tang (?????)

1 (50.0)

Palmul-tang+Ganghwang-san (???+???)

1 (50.0)

Gunggwijohyeoreum-gami (???+???)

1 (50.0)

Yijinsamultang-gami (?????-??)

1 (50.0)

Bojungikgitang-gami (?????-??)

1 (50.0)

Ovarian Cyst

(n=2)

Saenghwa-tang (???)

1 (50.0)

Banchong-san (???)

1 (50.0)

Banchong-san-gami (???-??)

1 (50.0)

Yikwiseungyang-tang (?????)

1 (50.0)

Table 5: Herbal Medicine of Case Studies according to Patient’s Diseases.

Classification of the herb medicines by traditional Korean medicine patterns: Table 6 shows the classification result of the herb medicines used in 10 out of 12 case studies of CPP by their traditional Korean medicine patterns.

Traditional Korean Medicine Pattern

Herbal Medicine

Blood Stasis

Symptom

(???)

Qi Stagnation and

Blood Stasis

(????)

Seonghyangjeonggi-san (?????)

Blood Stasis

(??)

Saenghwa-tang (???)

Banchong-san (???)

Jogyeongjongoktang-gami (?????-??)

Qi Stagnation

(??)

Ilguan-jeon (???)

Banchongsan-gami (???-??)

Jogyeongjongoktang-gami (?????-??)

Deficiency

Symptom

(??)

Deficiency Cold

(??)

Banchongsan-gami (???-??)

Gwibi-tang+Gyoaesamul-tang (???+?????)

Gwibitang (???)

Yikwiseungyang-tang (?????)

Liver-Kidney Yin Deficiency (????)

Kidney Deficiency

(??)

Paljung-san (???)

Sibimijihwangtang-gagam (??????-??)

Qi Deficiency (??), Blood Deficiency (??),

Qi and Blood Deficiency (???)

Yikwiseungyang-tang (?????)

Bojungikgitang-gami (?????-??)

Samultang-gagam (???-??)

Jogyeongjongoktang-gami (?????-??)

Yin Blood Deficiency (???)

Yijinsamultang-gami (?????-??)

Heat

Symptom

(??)

Small Intestinal Excess Heat (????)

Simmidojeok-san (?????)

Blood Heat

(??)

Banchongsan-gagam (???-??)

Etc.

Liver-Spleen Disharmony

(????)

Gamisoyosan-gami (?????-??)

Cold Lower Abdominal Colic (??)

Banchongsan-gami (???-??)

Blood Stasis + Blood Deficiency

(?? + ??)

Gunggwijohyeoreum-gami (?????-??)

Table 6: Traditional Korean Medicine Pattern of Case Studies of Chronic Pelvic Pain.

Classification by moxibustion points

Of the 12 case studies of CPP involving TKM treatments, 8 studies used a total of 10 moxibustion points. A total of five moxibustion points were used in more than two studies; CV4 (??) was used in 7 studies (87.5%), making it the largest in number; CV12 (??) in 6 studies (75.0%); CV3 (??) and ST25 (??) in 3 studies respectively (37.5%); and CV6 (??) was used in 2 studies (25.0%) (Table 7).

Moxibustion Point

Chinese Name

Number of Papers

n(%)

CV4

??

7 (87.5)

CV12

??

6 (75.0)

CV3

??

3 (37.5)

ST25

??

3 (37.5)

CV6

??

2 (25.0)

Table 7: Moxibustion Point of Case Studies of Chronic Pelvic Pain.

Classification by outcome

A total of 11 outcomes were used in the 12 case studies of CPP. Four outcomes were used in more than one study. NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) and VAS (Visual Analogue Scale) were used in 5 studies (41.7%), which was the largest in number; IPSS (International Prostate Symptom Score) and NRS (Numerical Rating Scale) were used in 2 studies (16.7%) (Table 8).

Outcome Measure

Number of Papers

n(%)

NIH-CPSI

5 (41.7)

VAS

5 (41.7)

IPSS

2 (16.7)

NRS

2 (16.7)

Table 8: Outcome Measure of Case Studies of Chronic Pelvic Pain.

DISCUSSION

For this study, a total of 11 databases were used to understand the trend of the case studies regarding TKM treatments on CPP, in order to gather and analyze the related study articles. Case studies are studies that explain the cases in clinical practices. They are highly relevant to the clinical contexts and form new research questions [24,25]. Case studies also contribute to establishing the support for TM in the medical clinics or at home and the designing of randomized controlled trials, which are used as the key supporting materials for the recognition of such treatments by the national institutions. Therefore, when a TM for CPP is selected, or when a randomized and controlled study is designed, the findings of this study should be considered.

In the 12 case studies on CPP that were finally included in this study, a total of 9 treatments were used. Four treatments were used in more than one study, namely acupuncture in 11 studies (91.7%), herb medicine in 10 (83.3%), moxibustion in 8 (66.7%), and pharmacopuncture in 3 (25.0%). More than half of the studies were using acupuncture, herb medicine, and moxibustion. And, in most of the studies, the results were improved. Therefore, as the TM for CPP patients, acupuncture, herb medicine and moxibustion should be considered as the primary options.

The pharmacopuncture used in 3 studies is a new form of acupuncture therapy that injects herbal extracts into acupoints [26]. Pharmacopuncture is based on the theory of TKM, and is practiced in TKM clinics [27]. Today, pharmacopuncture is covered by automobile insurances in South Korea. And, many TKM clinics use this method frequently, among other treatment options [28]. A future clinical study is mandated to verify the effectiveness of pharmacopuncture in CPP, by integrating pharmacopuncture, which is frequently used in the clinical treatment of CPP and the acupuncture points that were proven to be effective in this study.

The result of the classification of the acupuncture points used in 11 studies out of the 12 case studies showed that patients with CPP and accompanying chronic prostatitis were acupunctured at PC6, SP6, GV20, KI7, LI11, SP9 and ST36, while the patients with CPP and accompanying endometriosis were treated at CV3, CV4, and SP6. The patients with CPP and accompanying adenomyosis were treated at CV3, CV4 and SP6, while those with ccc and accompanying ovarian cyst were acupunctured at SP6. Chronic prostatitis is a disease found among men, while endometriosis, adenomyosis, and ovarian cyst are diseases that affect women. It is recommended to consider the sex and accompanying diseases when selecting the acupuncture points for treating CPP.

In TKM, CPP is known to be related to the liver meridian (??), kidney meridian (??), bladder meridian (???), conception vessel (??), and governor vessel (??) [2]. The acupuncture points used in case studies can be classified by their meridians into spleen meridian(??), stomach meridian(??), liver meridian(??), kidney meridian(??), large intestine meridian(???), pericardium meridian(???), conception vessel(??) and governor vessel(??). The number of available clinical studies is too small to make recommendations on the selection of meridians rather than specific acupuncture points, which mandates future clinical studies and scientific analyses.

In this study, a total of 17 herb medicines were used in 10 case studies, and these were classified based on their traditional Korean medicine patterns and diseases. Herb medicines have been used for thousands of years to treat a number of diseases, as one of the preferred forms of TM [29,30]. They are used as prescription types, mixing more than one medicinal material based on TM texts in South Korea, China, Taiwan and Japan [31]. However, as the number of prescriptions identified in this study was vast, it is necessary to gather more clinical data to make recommendations on the prescriptions based on the diseases of the CPP patients and traditional Korean medicine patterns.

In western medicine, there is no treatment of CPP unless the cause of the pain is identified. However, in TM, the meridians and traditional Korean medicine patterns can be used to apply acupuncture, moxibustion, and cupping to patients. The implication of this study is that the clinical ground for TM of CPP and it is the hope of the researcher that this study can be used as the support for making recommendations of traditional treatments as a part of the treatment guidelines for CPP.

CONCLUSION

TKM treatment such as acupuncture, moxibustion, herbal medicine seems to be an effective treatment in patients with CPP. However, the number of case studies found in this study was not sufficient, while the evidence level was also too low, to make recommendations on TM treatment for CPP. Future studies of High-quality RCT are needed in order to make decisions on whether TM treatments should be used for treating CPP.

ACKNOWLEDGEMENT

This work was supported by the Policy Support Project for the Development of Traditional Korean Medicine funded by the Ministry of Health and Welfare.

CONFLICTS OF INTEREST

The authors declare that there are no conflicts of interest regarding the publication of this paper.

REFERENCES

  1. ACOG Committee on Practice Bulletins-Gynecology (2004) ACOG Practice Bulletin No. 51. Chronic pelvic pain. Obstet Gynecol 103: 589-605.
  2. Lee TK (1997) A literature review of chronic pelvic pain. J Korean Obstet Gynecol 10: 111-119.
  3. Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, et al. (2015) EAU guidelines on chronic pelvic pain. Eur Urol 57: 35-48.
  4. Ahangari A (2014) Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 17: 141-147.
  5. Roberts RO, Lieber MM, Rhodes T, Girman CJ, Bostwick DG, et al. (1998) Prevalence of a physician-assigned diagnosis of prostatitis. Urology 51: 578-584.
  6. Gong TX (1990) Rejuvenate of all diseases. Beijing: People’s Medical Publishing House Co, LTD, Beijing, China.
  7. Zhu ZH (1984) Pulse, caouses, symptom and treatment. Shanghai: Shanghai Scientific & Technical Publishers, China.
  8. Zhang ZJ (1990) Yugyeongdoig. Seoul: Daesung Print, China.
  9. Kim SY, Yoon JW (1996) The study on chronic pelvic pain in oriental and occidental medicine. J Korean Obstet Gynecol 5: 15-31.
  10. Sung SH, Sung AD, Sung HK, An TE, Kim KH, et al. (2018) Acupuncture treatment for chronic pelvic pain in women: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2018;2018: 9415897.
  11. 11.    Carinci AJ, Pathak R, Young M, Christo PJ (2013) Complementary and alternative treatments for chronic pelvic pain. Curr Pain Headache Rep 17: 316.
  12. Kang HC, Choi WK, Jung MY, Lee SG (2004) Clinical study on a case of somatoform disorder with chronic pelycalgia and hemiparesis. J of Oriental Neuropsychiatry 15: 203-210.
  13. Rim SY, Oh ST (2005) The effect of subcutaneous injection of mistletoe extract for the treatment of chronic pelvic pain. Obstetrics &Gynecology Science 48: 1288-1292.
  14. Yi YJ, Yang SI, Han IS (2006) Treatment of the chronic pelvic pain and complications of post-ovarian cystectomy with laparoscopy: a case report. J Korean Obstet Gynecol 19: 287-297.
  15. Yu SJ, Yoon MH, Kim HJ, Lee DN (2009) A case report of one patient with adenomyosis. J Korean Obstet Gynecol 22: 205-214.
  16. Youn SS, Park SW, An SH, Cho C-S, Kim C-J (2010) A Retrospective Study on 15 Patients of Chronic Prostatitis/ Chronic Pelvic Pain Syndrome. Korea J Oriental Int Med 31: 914-922.
  17. Ohlsen BA (2013) Acupuncture and traditional Chinese medicine for the management of a 35-year-old man with chronic prostatitis with chronic pelvic pain syndrome. J chiropr Med 12: 182-190.
  18. Lee JI, Kang MS (2014) Effect of meridian tendino-musculature acupuncture on a patient with chronic prostatitis. The Acupuncture 31: 223-232.
  19. Kim J-H, Kang N-H, Chae M-S, Hwang D-S (2015) 6 case series of the chronic pelvic pain by Korean medicine therapies. J Korean Obstet Gynecol 28: 143-155.
  20. Kim S-J, Kim B-K, Kang S-S, Jung H-J, Jung S-K, et al. (2015) Chronic non-bacterial prostatitis treated with additional immune pharmacopuncture: a case report. Korea J Oriental Int Med 36: 436-445.
  21. Kim S, Hwnag D, Lee JM (2015) A case report of endometriosis patient: evaluated by total symptom distress and short-from endometriosis health profile questionnaire. J Korean Obstet Gynecol 28: 106-117.
  22. Park NC, Kang NH, Kim JH, Yoo E-S, Pak Y-K, et al. (2016) A case study on Korean medicine treatment for unexplained hematuria with chronic pelvic pain. J Korean Obstet Gynecol 29: 100-109.
  23. Yu BK, Lee E (2016) Chronic prostatitis/chronic pelvic pain syndrome 6 case series. J Physiol & Pathol Korean Med 30: 201-208.
  24. Sayre JW, Toklu HZ, Ye F, Mazza J, Yale S (2017) Case reports, case series - from clinical practice to evidence-based medicine in graduate medical education. Cureus 9: 1546.
  25. Park BC (2011) Evidence based medicine in spine surgery. J Korean Soc Spine Surg 18: 174-178.
  26. Park J, Lee H, Shin BC, Lee MS, Kim B, et al. (2016) Pharmacopuncture in Korea: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2016: 4683121.
  27. Lee YJ, Shin JS, Lee J, Kim MR, Park KB, et al. (2016) Usage report of pharmacopuncture in musculoskeletal patients visiting Korean medicine hospitals and clinics in Korea. BMC Complement Altern Med 16: 292.
  28. Yoon SA, Lee SY (2017) Current status and improvement of traditional Korean medical treatment for car insurance. Seoul: Korea Insurance Research Institute, Korea.
  29. Park B, Jun J, Jung J, You S, Lee M-S (2014) Herbal medicines for cancer cachexia: protocol for a systematic review. BMJ Open 4: 005016.
  30. Thomas K, Coleman P (2004) Use of complementary or alternative medicine in a general population in Great Britain. Results from the national omnibus survey. J Public Health (Oxf) 26: 152-167.
  31. Pusan national university (2018) A study on establishment of foundation for strengthening the health insurance coverage of herbal medicine (decoction). Wonju: National Health Insurance Service.

Citation: Sung S-H, Sung A-D-M, Yeon J-H, Park J-K, Jung W-C (2020) Interventions of Traditional Korean Medicine for Chronic Pelvic Pain: A Literature Review of Case Studies. J Altern Complement Integr Med 6: 090.

Copyright: © 2020  Soo-Hyun Sung, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

© 2021, Copyrights Herald Scholarly Open Access. All Rights Reserved!