American Osteopathic Association Guidelines for Osteopathic Manipulative Treatment (OMT) for Patients With Low Back Pain

Abstract

The authors of the systematic review identified 307 studies. Thirty-one were evaluated and 16 were excluded. Of the 15 studies included in the review, 6 were retrieved from Germany, 5 from the United States, 2 from the United Kingdom, and 2 from Italy. Two additional studies published after the Franke et al review were also included. Osteopathic manipulative treatment significantly reduces pain and improves functional status in patients, including pregnant and postpartum women, with nonspecific acute and chronic LBP. Franke et al found that in acute and chronic nonspecific LBP, moderate-quality evidence suggested that OMT had a significant effect on pain relief (mean difference [MD], -12.91; 95% CI, -20.00 to -5.82) and functional status (standard mean difference [SMD], -0.36; 95% CI, -0.58 to -0.14). More specifically, in chronic nonspecific LBP, the evidence suggested a significant difference in favor of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). When examining nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favor of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23). Conversely for nonspecific LBP postpartum, Franke et al found that moderate-quality evidence suggested a significant difference in favor of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35).2 CONCLUSION: The conclusions of Franke et al further strengthen the findings that OMT reduces LBP. In a 2005 systematic review conducted by Licciardone et al3 and the basis of the LBP guidelines published in 2010, it was determined that OMT reduces pain more than expected from placebo effects alone, and these results had the potential to last beyond the first year of treatment. Franke et al specifically stated that clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women 3 months after treatment. Larger randomized controlled trials with robust comparison groups are needed to further validate the effects of OMT on LBP. In addition, more research is needed to understand the mechanics of OMT and its short- and long-term effects, as well as the cost-effectiveness of such treatment.

Osteopathic Manipulative Treatment Effect on Pain Relief and Quality of Life in Oncology Geriatric Patients: A Nonrandomized Controlled Clinical Trial

“…Osteopathic treatment protocols formulated from this algorithm should include the interdependence of osteopathic principles of body unit, homeostasis and the relationship between structure and function for the management of chronic pain. The recent osteopathic treatment guidelines for low back pain, published in 2016, 16 confirmed the effectiveness of osteopathic treatment on chronic pain and the importance of setting up the treatment on the osteopathic algorithm for chronic pain. In literature, there are many studies that show the effectiveness of this approach in various clinical conditions associated with chronic pain, such as musculoskeletal disorders, spinal cord injury, 18 geriatric disorders, 14 cardiological disorders, 30 gynecological disorders, 31 pregnancy, 32 and gastrointestinal disorders.…”

“…Diagnosis and treatment were founded on 5 models: biomechanics, neurologic, metabolic, respiratory-circulatory, and behavior. 16 , 28 The OMT protocol was administered by an osteopath with clinical experience of 10 years in one-on-one individual sessions. The techniques used were: dorsal and lumbar soft tissue, rib raising, back and abdominal myofascial release, cervical spine soft tissue, suboccipital decompression, and sacroiliac myofascial release.…”

“… 13 One of the effective complementary therapies for pain management is osteopathic manipulative treatment (OMT), a nonpharmacologic way of addressing chronic pain in older persons. 14 , 15 OMT is the therapeutic application of a variety of techniques to improve physiologic functions and restore homeostasis altered by somatic dysfunction 16 (ICD-101CM Diagnosis Code M99.09-09), resulting in pain and in peripheral and visceral inflammation. 17 , 18 …”

Role of Opioid-Involved Drug Interactions in Chronic Pain Management

“…6 A substantial body of evidence supports the effectiveness of OMT as an adjunctive therapy for chronic pain management, particularly for low back pain. 41,42 In 2016, the American Osteopathic Association published their updated guidelines 42 for OMT, further strengthening the evidence for using OMT alone or with other nonpharmacologic therapies. If after examining the patient and assessing the pain, health care professionals choose to prescribe a drug, they should first consider nonopioid therapies, such as acetaminophen, nonsteroidal anti-inflammatory drugs, anticonvulsants, and antidepressants.…”

Post-sternotomy pain syndrome following cardiac surgery: case report

“…Osteopathic manipulative treatment (OMT) is defined as: “The therapeutic application of manually guided forces by osteopathic physician, to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.”13 The somatic dysfunction is defined as: “Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements.”14…”