Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials

Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
BMC Musculoskeletal Disorders (Impact Factor: 1.9). 02/2005; 6:43. DOI: 10.1186/1471-2474-6-43
Source: PubMed

ABSTRACT Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain.
Computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen's d statistic and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, stratified meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and stratified meta-analyses.
Overall, OMT significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 - -0.13; P = .001). Stratified analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, intermediate-, and long-term follow-up.
OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: T wenty-five years ago, when I was a student at the Michigan State Uni-versity College of Osteopathic Medicine in East Lansing, Robert C. Ward, DO, and other members of the Educational Council of Osteopathic Principles (ECOP) challenged me and several other osteopathic medical students to search the scientific literature for evi-dence supporting osteopathic medi -cine's philosophical approach to patient care. I found that osteopathic philos-ophy and its tenets are well founded upon the sciences of anatomy and phys-iology, as well as upon patient outcome studies. I also found that contemporary science supported many of the approaches Andrew Taylor Still, MD, DO, and his students proposed for a variety of dysfunctions and diseases. The Council of Deans charged ECOP to develop a standard evidence-based osteopathic curriculum for use as a guide and template for all colleges of osteopathic medicine. I helped develop that document from 1984 to 1986. By the time I graduated in 1988, ECOP, which is a council of the American Association of Colleges of Osteopathic Medicine (AACOM), had developed a well-refer-enced, evidence-based outline for a stan-dard core curriculum for osteopathic principles and practice (OPP). In using the curriculum, osteopathic medical schools identified themselves as uniquely osteopathic, and their gradu-ates carried the osteopathic philosophy with them to each patient encounter. The core curriculum led to the development of the American Osteo-pathic Association's standard textbook Foundations for Osteopathic Medicine, 1 of which I have been a section editor from its beginning. Now in its third edition, the textbook is a multidisciplinary, comprehensive, peer-reviewed, evi-dence-based, state-of-the-art reference, through out which resonates the osteo-pathic philosophy, including the AOA-en dorsed tenets of osteopathic medicine. 2 Foundations' third edition is a synergy of the profession's scientific foundations and its art of practice, and it is based on a health-oriented philosophy that will guide generations of medical students and physicians in providing patient-cen-tered osteopathic medical care through -out the world. From 1995, when the first Founda-tions was in the works, through 2008, I taught evidence-based manual medicine courses for allopathic physicians at the American Academy of Family Physi-cians' annual scientific assembly. These courses led to the development of an evidence-based manual medicine text-book that I cowrote with Raymond J. Hruby, DO, FAAO, in 2007. 3 With Felix J. Rogers, DO, I launched "The Somatic Connection" column in JAOA—The Journal of the American Osteopathic Association in 2006 to help readers keep abreast of the burgeoning evidence-based national and interna-tional literature relevant to OPP, espe-cially osteopathic manipulative treat-ment (OMT). Needless to say, I have been keeping up to date on the world's sci-entific literature regarding OMT and other aspects of OPP.
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Unbalanced 3-factor design with repeated measures on 1 factor. To determine the effect of manual treatment (MT) on cytokine and pain sensations in those with and without low back pain (LBP). Evidence suggests MT reduces LBP but by unknown mechanisms. Certain cytokines have been elevated in patients with LBP and may be affected by MT. Participants aged 20-60 years with chronic LBP or without LBP were recruited and randomly assigned to MT, sham ultrasound treatment, or no treatment groups. Venous blood samples were collected and pain levels assessed at baseline, 1 hour later, and 24 hours later. Blood was analyzed for interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and C-reactive protein (CRP). Pain levels were measured by pressure pain threshold (PPT), mechanical detection threshold (MDT), dynamic mechanical allodynia (DMA), and self-report. Forty (30 female, age 36±11 y) participants completed the study, 33 with LBP (13 MT, 13 sham ultrasound treatment, and 7 no treatment) and 7 without LBP. Participants with or without LBP could not be differentiated on the basis of serum cytokine levels, PPT, or MDT (P≥0.08). There were no significant differences between the groups at 1 hour or 24 hours on serum cytokines, PPT, or MDT (P≥0.07). There was a significant decrease from baseline in IL-6 for the no treatment (LBP) group (P=0.04), in CRP for the sham ultrasound treatment group (P=0.03), in MDT for all 3 LBP groups (P≤0.02), and in self-reported pain for the MT and sham ultrasound treatment groups (P=0.03 and 0.01). Self-reported pain was reduced with MT and sham ultrasound treatment 24 hours after treatment, but inflammatory markers within venous circulation and quantitative sensory tests were unable to differentiate between study groups. Therefore, we were unable to characterize mechanisms underlying chronic LBP.
    Journal of Spinal Disorders & Techniques 12/2014; DOI:10.1097/BSD.0000000000000231 · 1.89 Impact Factor

Preview (2 Sources)

Available from