Efficacy of Hot Herbal Compression (Chingdug) compared to Diclofenac gel in the management nonspecific low back pain in Bhutan: a randomized non-inferiority trial

Introduction: In Bhutanese Traditional Medicine, Chingdug therapy is available for the treatment of chronic low back pain. In this study, the effectiveness of Chingdug was compared with self-administered Diclofenac 1% gel in the management of nonspecific low back pain. Method: A randomized non-inferiority trial was conducted among patients with nonspecific low back pain at National Traditional Medicine Hospital, Bhutan. Participants were randomly allocated to the Chindgug therapy (n = 30) delivered as per standard protocol and self-administered Diclofenac 1% gel (n = 30) groups. Primary outcomes were at baseline and weekly for two weeks. Results: At the end of Week 2, 83.33% in the Chingdug group had a moderate score on Visual Analogue Scale compared to 63.33% in the Diclofenac group (p = 0.080). The mean Visual Analogue Scale score reduced from 5.47 at baseline to 3.49 at Week 2 (p < 0.05) in the Chingdug group while it reduced from 5.67 to 3.63 in the Diclofenac group (p < 0.05). There was a decrease in the Oswestry Disability Index score from 57.17 at baseline to 39.93 at Week 2 in the Chingdug group (p < 0.05) while it reduced from 60.20 to 49.93 in the Diclofenac group (p < 0.05). There was an increase in Modified Lumbar Schober Test score from 1.22 at baseline to 2.29 at Week 2 in the Chingdug group while it increased from 1.23 to 2.33 in the Diclofenac group. Conclusions: Both Chingdug therapy and diclofenac gel showed a reduction in pain symptoms and disability and an improvement in lumbar range of motion.