Impact of Osteopathic Treatment on Pain in Adult Patients with Cystic Fibrosis – A Pilot Randomized Controlled Study

Abstract

BackgroundPain is a common complication in patients with cystic fibrosis (CF) and is associated with shorter survival. We evaluated the impact of osteopathic manipulative treatment (OMT) on pain in adults with CF.MethodsA pilot multicenter randomized controlled trial was conducted with three parallel arms: OMT (group A, 16 patients), sham OMT (sham treatment, group B, 8 patients) and no treatment (group C, 8 patients). Medical investigators and patients were double-blind to treatment for groups A and B, who received OMT or sham OMT monthly for 6 months. Pain was rated as a composite of its intensity and duration over the previous month. The evolution of chest/back pain after 6 months was compared between group A and groups B+C combined (control group). The evolution of cervical pain, headache and quality of life (QOL) were similarly evaluated.ResultsThere was no statistically significant difference between the treatment and control groups in the decrease of chest/back pain (difference = −2.20 IC95% [−4.81; 0.42], p = 0.098); also, group A did not differ from group B. However, chest/back pain decreased more in groups A (p = 0.002) and B (p = 0.006) than in group C. Cervical pain, headache and QOL scores did not differ between the treatment and control groups.ConclusionThis pilot study demonstrated the feasibility of evaluating the efficacy of OMT to treat the pain of patients with CF. The lack of difference between the group treated with OMT and the control group may be due to the small number of patients included in this trial, which also precludes any definitive conclusion about the greater decrease of pain in patients receiving OMT or sham OMT than in those with no intervention.Trial RegistrationClinicalTrials.gov NCT01293019

Pain and its clinical associations in individuals with cystic fibrosis

“…2,3,19,21, 25,27,37 Current guidelines have suggested that efforts to minimize some causes of pain are within the scope of physiotherapy practice, which may include physical modalities. 1,35 Whilst this may incorporate manual treatment and exercises for optimal posture, mobility and muscle function, 1,32,38 –40 options (including the use of heat and ice) and psychological interventions (distraction, relaxation, mindfulness and counselling) are also warranted. Further study is required to determine the most effective treatment strategies.…”

Herausforderungen der Therapie thorakaler Schmerzen bei zystischer Fibrose (CF)

“…Eine einzige prospektive Pilotstudie zeigte eine Reduktion von Gelenkschmerzen und Angst durch regelmäßige Yogastunden [28]. Eine RCT zur Osteopathie fand einen nichtsignifikanten Rückgang von Thorax-und Rückenschmerzen [15]. Es erfolgte stets eine resistogrammgerechte antibiotische Therapie, Atemphysio-und Inhalationstherapien.…”

Zystische Fibrose und Schmerzen – ein unterschätztes Problem

“…In den von uns erfassten Studien, die auch in der aktuellen Übersichtsarbeit von Trandafir et al enthalten sind [32] Therapieoptionen wie Yoga und Osteopathie wurden auch prospektiv geprüft (s. unten) [15,20].…”

“…Zusätzlich versuchen sich einige Patienten in alternativen Strategien und Therapieansätzen, die von Homöopathie über Akupunktur bis zu physikalischen Maßnahmen (Ruhe oder Aktivität, Wärme oder Kälte, Yoga und Meditation, Osteopathie) reichen [15,20,30,32]. Hier existieren wenige prospektive Studien zu Wirksamkeit und Effektivität.…”