The Effect of Comprehensive and Integrative Medical Services on Patients with Degenerative Lumbar Spinal Stenosis : A Randomized Controlled Study

Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently menifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and integrative medical services (CIMS) – a multimodal program consisting of acupuncture, cupping, and manual therapy – have been increasingly incorporated into clinical practice in Korea. However, randomized evidence remains limited. This study evaluated the efficacy and safety of adjunctive CIMS in patients with DLSS presenting neuropathic LLRP requiring SNRB. Materials and Methods: In a single-center, parallel-group, assessor-blinded randomized controlled trial (CRIS KCT0006036), adults with DLSS (LANSS > 7; VAS > 5) were randomized 1:1 to experimental or control groups (n = 77; experimental 38, control 39). All participants received SNRB plus pharmacotherapy (limaprost, pregabalin). The experimental group additionally received CIMS, delivered 8 times over 4 weeks. The primary outcome was pain intensity (VAS) at baseline, weeks 4,8, and 12. Secondary outcomes included SF-36, ODI, and RMDQ at baseline, weeks 4,8 and 12. Repeated-measures two-factor ANOVA assessed main effects and time x group interaction. Results: Mean VAS (experimental vs. control) was 4.73±1.67 vs. 4.70±1.95 at baseline; 3.74±1.68 vs. 4.66±1.60 at week 4; 3.93±2.03 vs. 4.79±1.55 at week 8; 3.98±1.98 vs. 4.98±1.68 at week 12. The significant time x group interaction was identified (p = 0.040), indicating a greater pain reduction with CIMS. No significant time x group interactions were observed across SF-36 domains. Adherence to CIMS modalities was high, and no unexpected adverse events occurred. Conclusions: In DLSS patients receiving SNRB and pharmacotherapy, adjunctive CIMS resulted in greater pain reduction over 12 weeks compared with standard care alone, without introducing new safety concerns. These findings support the clinical utility of CIMS as an effective adjunctive treatment option for DLSS.