Ask an answerable question (PICO)：
Chronic lower back pain (CLBP) is a common symptom that usually refers to back pain on both sides of the lumbar spine. Most cases are due to direct or indirect physical forces, and few are caused by internal disease. Common treatment options include pharmacological treatment, physical therapy, and surgery. This kind of pain affects the patient’s quality of life, and its medical expenses account for a considerable proportion of health insurance resources. In outpatient departments, patients often complain of CLBP and its effect on daily activities. Western oral medicine is the primary treatment option for CLBP ; however, many patients are concerned about medication’s side effects and often seek other treatment methods to reduce medicine intake and pain. On the other hand, Gua Sha tools are easy to obtain, cheap, and have fewer side effects than Western pharmaceuticals. They reduce not only medical expenditure, but also achieve optimal health care effects. Therefore, this article determines via literature review whether or not Gua Sha can help significantly reduce pain levels of CLBP. If it shows promising results, the correct method and knowledge of Gua Sha can be promoted for patients with CLBP.
The Method and Analysis of Literature Review：
This literature search is based on PICO keywords and synonyms using PubMed, Cochrane Library, Embase Evidence-based Medicine, CINAHL Complete database, Airiti Library, and the National Digital Library of Theses and Dissertations in Taiwan. We restricted the search to systematic reviews and randomized controlled trial literature over the past five years in Chinese or English. Furthermore, we used Boolean logic such as AND, OR, NOT, and Limit as our data collection strategy and obtained 24 papers. We found one systematic review for critical appraisal after eliminating the unmatching and repeated content.
Critical Appraisal：
This literature was a Systematic Review (SR) conducted in 2021. The level of evidence is Level 1 according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. We also used the 2018 Critical Appraisal Skill Program (CASP) Levels of Evidence System to evaluate this article's validity, importance, and applicability outcomes; the article obtained a total score of 10. The study aimed to investigate whether Gua Sha treatment could relieve the pain of participants (age ≥ 18 years) diagnosed with CLBP. The meta-analysis results demonstrate the statistical significance of Gua Sha treatment on the reduction of lower back pain, concluding that Gua Sha treatment can effectively reduce pain levels in patients with CLBP.
Results, Conclusions and Recommendations：
According to the PICO problem evaluation conclusion in the literature, Gua Sha treatment helps reduce the pain level of CLBP. The treatment also improves the functionality of the lumbar spine by unblocking circulation and regulating Qi (energy) and blood flow. This clinical treatment is simple, safe, inexpensive, and has fewer side effects than Western pharmaceutical options; however, it is used less in the traditional Chinese medicine outpatient setting since each treatment takes longer. This treatment caused some to experience adverse effects due to improper technique. Based on the literature, we can discuss target body areas, duration, frequency, and contraindications of Gua Sha treatment with Chinese medicine doctors; hence, we provide health education on Gua Sha treatment, including concept and scraping techniques, so that patients can self-administer safely and reduce wait times for treatment.
