A survey on the clinical practice of herpes zoster and postherpetic neuralgia management by Korean medicine doctors: towards the development of Korean medicine clinical practice guidelines.

BACKGROUND: Herpes zoster (HZ) is a painful viral disease caused by varicella-zoster virus reactivation. Postherpetic neuralgia (PHN), characterized by severe pain, is its most frequent complication. Due to the limitations of western medicine (WM) in managing these conditions, there is increasing demand for Korean medicine (KM). However, Korean medicine clinical practice guidelines (KM-CPGs) for HZ and PHN are not yet established. This study investigates current clinical practices and perceptions of Korean medicine doctors (KMDs) regarding HZ and PHN to facilitate KM-CPGs development. METHODS: An online survey was conducted from May 6 to May 15, 2024. Participants were notified via short message services and email. The survey, based on literature reviews, expert consultations, and previous surveys, was divided into sections on clinical practice status, diagnosis, treatment, progress, prognosis, prevention, and perceptions. RESULTS: A total of 1,122 KMDs responded. Pain or sensory abnormalities were most frequently considered in diagnoses and prognoses. KMDs used an average of 4.72 KM treatments. Acupuncture (93.2%) was the most commonly used treatment, followed by herbal medicine (75.6%) and pharmacopuncture (63.8%). Herbal medicine was rated as the most important treatment (94.6%), followed by acupuncture (90.1%) and pharmacopuncture (75.3%). The primary treatment goal was to alleviate pain or sensory abnormalities. Significant differences were observed across KMDs' experience groups in the perceptions of objective diagnostic tools (heart rate variability/Ryodoraku and digital infrared thermal imaging). Experience levels also affected the perceived importance of acupuncture and herbal medicine, with longer experience groups generally rating them higher. Notably, the > 10 years group rated the safety of acupuncture and herbal medicine significantly higher than the < 5 years group (p < 0.001). CONCLUSION: This first large-scale study addresses a critical gap, establishing a strong clinical consensus among KMDs prioritizing pain relief using a multimodal strategy (acupuncture, herbal medicine, and pharmacopuncture). The findings highlight the urgent need to standardize objective diagnostic protocols and provide an evidence-informed foundation for developing KM-CPGs, which can effectively complement WM in improving patient outcomes for HZ and PHN.