Types and Doses of Pharmacopuncture for Lumbar Disc Herniation: a scoping review of clinical studies

Lumbar disc herniation (LDH) symptoms include lower back pain (LBP), radiating leg pain, and muscle weakness in muscles innervated by the affected nerve roots. The treatment of LDH is divided into conservative and surgical treatments. In this study, we aimed to summarize and analyze the clinical studies of pharmacopuncture (PP) on LDH and to assess its utilization rate in clinical practice.

In this scoping review, we searched both the domestic (Research information sharing service [RISS], SCIENCE ON, online access to shared information system [OASIS]), and international (PubMed) databases to gather case reports, retrospective studies, and randomized controlled trials with information on the types and doses of PP by injection points up to September 3rd, 2024. The information obtained was analyzed using the PP type and dose at each injection point.

Sixty-three studies were identified for this study. We observed that bee venom was most used (34 studies), followed by Shinbaro (29 studies). Studies on other PP types did not exceed four each. The PP doses ranged from a minimum of 0.04 cc to a maximum of 6.00 cc. The most used dose was 1.00 cc. Injection points were intradermal at each disc level, Ah-Shi points, tender points, muscles, traditional acupoints, and facet joints.

We analyzed variations in injection points and maximum doses of PP according to substance type and anatomical location. These results support the development of standardized protocols for acupoint injection therapy in patients with LDH.