Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical approach

Abstract

The biopsychosocial mechanisms for therapeutic effect in an osteopathic treatment encounter for people with somatic pain were reviewed and discussed in Part 1 of this article. The author argued that both biological and psychosocial therapeutic mechanisms are potentially important in clinical practice, although the relative importance of these mechanisms differs depending on the person's presentation and the nature and chronicity of the involved pain. In Part 2, clinical implications of the differing processes of pain and therapeutic mechanisms of osteopathic techniques are discussed. A rationale is presented for osteopathic management based on an understanding of the likely biological and psychological factors present and for the complementary actions of manual therapy with a cognitive behavioural approach to pain and disability. Appropriate communication, reassurance, education, and empowerment can result in positive attitudes and behaviours to pain and complement the specific biological effects of osteopathic manipulative treatment.This article will aid the clinical reasoning process and provide guidance to osteopaths for treatment selection based on patient presentation and the likely biological and psychological factors involved in pain and disability.

‘I just don't have the tools’ - Italian osteopaths' attitudes and beliefs about the management of patients with chronic pain: A qualitative study

“…Through critical self-reflection on biomechanical theories and models which are thought be be central to an osteopathic approach, [39,40], practitioners should appraise the value and plausibility of their dominant approaches and practice paradigms that guide their clinical work as well as to better reconceptualise and expand the rationale of the therapeutic effects of the osteopathic manipulative treatment (OMT) in patients with musculoskeletal related chronic pain [29,60]. This would enable the development of more person-centered framework, that may help osteopaths to enhance their confidence and competence in the identification of obstacles to healing, outside the "joint" [30,47]. Moreover, critical reflection may also assist osteopaths in their attempts to better understand the nature of patients with long term pain, adopting and consolidating non-physical based "soft skills", especially when looking to facilitate empowerment and self-efficacy of individuals in this challenging and complex patient group.…”

Patient Active Approaches in Osteopathic Practice: A Scoping Review

“…It could be helpful to use metaphors to explain concepts [ 33 ], but osteopaths must be aware that positional terminology (e.g., flexed and rotated vertebra) is anachronistic and potentially dangerous for patients. Adopting such terminology can establish the idea of a severe condition in the mind of an anxious person, leading to catastrophizing, fear-avoidance behavior, and dependence on passive approaches for something that “is gone out of place, and needs to be fixed” [ 37 ].…”

Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework

“…On the one hand, osteopathic hands-on approaches encompass diagnostic tests primarily using palpation and therapeutic techniques based on touch and manipulation to influence patients’ peripheral tissues. On the other hand, osteopathic hands-off approaches involve patient management procedures like patient education, psychological support, lifestyle advice, and self-management solutions to influence patients’ cognition and psychological state ( Fryer, 2017a , b ; Vaucher et al, 2018 ). Arguably, these hands-on and hands-off approaches act on peripheral tissues and the brain, respectively.…”