When to consider osteopathic manipulation

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Applied Evidence

When to consider osteopathic manipulation

J Fam Pract. 2010 May;59(5):E5-E8

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References

1. Leosho E. An overview of osteopathic medicine. Arch Fam Med. 1999;8:477-484.

2. Hart AC. ICD-9-CM Expert for Physicians. Vols 1 & 2. Eden Prairie, Minn: Ingenix; 2010.

3. Ward RC. ed. Foundations for Osteopathic Medicine. Baltimore, Md: Williams & Wilkins; 1997:3–14.

4. Salamon E, Zhu W, Stefano G. Nitric oxide as a possible mechanism for understanding the therapeutic effects of osteopathic manipulative medicine. Int J Mol Med. 2004;14:443-449.

5. McPartland JM, Giuffrida A, King J, et al. Cannabimimetic effects of osteopathic manipulative treatment. J Am Osteopath Assoc. 2005;105:283-291.

6. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

7. Low back pain, adult (guideline). Institute for Clinical Systems Improvement. November 2008. Available at: http://www.icsi.org/guidelines_and_more/gl_os_prot/ musculo-skeletal/low_back_pain/low_back_pain__adult_5. html. Accessed April 8, 2010.

8. Johnson SM, Kurtz ME. Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment. J Am Osteopath Assoc. 2002;102:527-532.

9. Licciardone J, Brimhall A, King L. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskel Dis. 2005;6:43-55.

10. Andersson GB, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341:1426-1431.

11. Licciardone J, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355-1362.

12. Williams NH, Wilkinson C, Russell I, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract. 2003;20:662-669.

13. Williams N, Edwards RT, Linck P, et al. Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial. Fam Pract. 2004;21:643-650.

14. Gamber R, Holland S, Russo DP, et al. Cost-effective osteopathic manipulative medicine: a literature review of cost-effectiveness analysis for osteopathic manipulative treatment. J Am Osteopath Assoc. 2005;105:357-367.

15. Hoyt WH, Shaffer F, Bard DA, et al. Osteopathic manipulation in the treatment of muscle-contraction headache. J Am Osteopath Assoc. 1979;78:49-52.

16. Anderson R, Seniscal C. A comparison of selected osteopathic treatment and relaxation for tension-type headaches. Headache. 2006;46:1273-1280.

17. McReynolds T, Sheridan B. Intramuscular ketorolac vs. osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc. 2005;105:57-67.

18. Mills MV, Henley CE, Barnes LL, et al. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Arch Pediatr Adolesc Med. 2003;157:861-866.

19. Guiney PA, Chou R, Vianna A, et al. Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc. 2005;105:7-12.

20. Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database Syst Rev. 2005;(2):CD001002.-

21. Hayden C, Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Compl Ther Clin Pract. 2006;12:83-90.

22. Mein EA, Greenman PE, McMillin DL, et al. Manual medicine diversity: research pitfalls and the emerging medical paradigm. J Am Osteopath Assoc. 2001;101:441-446.

23. Noll DR, Degenhardt BF, Stuart M, et al. Effectiveness of a sham protocol and adverse effects in a clinical trial of osteopathic manipulative treatment in nursing home patients. J Am Osteopath Assoc. 2004;104:107-113.

24. Licciardone J, Russo D. Blinding protocols, treatment credibility and expectancy: methodologic issues in clinical trials of osteopathic manipulative treatment. J Am Osteopath Assoc. 2006;106:457-463.

A few RCTs have investigated the role of OMT in adults with chronic low back pain. One study randomized 91 patients with non-specific back pain of more than 3 months’ duration to receive 7 sessions of OMT, 7 sessions of sham manipulative therapy, or usual care. (Sham manipulation consisted of range of motion and light touch without therapeutic intention.) Both OMT and sham therapy significantly decreased back pain at 1 month (P=.01 and P=.003, respectively), 3 months (P=.001, P=.01), and 6 months (P=.02, P=.02) compared with usual care.¹¹

A study conducted in the United Kingdom randomized 201 patients with spinal pain of 2 to 12 weeks’ duration to receive usual care or usual care plus 3 OMT sessions. At 2 months’ follow-up, the OMT group, compared with the usual care group, exhibited a significant reduction in spinal pain levels (95% CI, 0.7-9.8; P=.02) and in psychological distress secondary to spinal pain (95% CI, 2.7-10.7; P=.001). Both measures were rated on a scale of 0 to 100.¹²

A follow-up cost analysis between the usual care and usual care/OMT group found a nonsignificant difference in mean health care costs due to spinal pain for the duration of the study, estimated to be 58 £ ($88.13 US) in the usual care group and 47 £ ($71.42 US) in the OMT group.¹³ Authors of other studies have inferred potential health care cost savings associated with OMT for back pain based on workers’ compensation claims, lost work time, provider services, medication use, or length of hospital stay.¹⁴

Evidence basis for OMT in other disorders

Headache
One study randomized 22 subjects with tension-type headaches lasting longer than 6 months to 10-minute sessions of OMT, sham therapy, or supine rest. Participants rated their discomfort on a scale of 0 (absence of headache) to 7 (debilitating headache) before and after study intervention. Only the OMT group showed a significant immediate post-treatment reduction in patient-rated headache severity (P<.003).¹⁵

A more recent study examined 26 patients with tension headaches of similar severity and frequency at baseline. All 26 subjects received training in progressive muscular relaxation home exercises, while 14 subjects also received 3 OMT sessions over 3 weeks. At 6 weeks’ follow-up, the OMT group noted 1.79 headache-free days per week, compared with 0.21 headache-free days per week in the control group (P=.016).¹⁶

FAST TRACK

Patients receiving OMT showed significantly greater reduction in intensity of neck pain compared with those receiving ketorolac.

Neck pain
Fifty-eight patients with neck pain lasting longer than 3 weeks who sought care at an emergency department were asked to rate their pain intensity on an 11-point numerical scale before and after randomization to receive either 30 mg intramuscular ketorolac or a 5-minute OMT session. Both groups experienced a reduction in pain, 1.7±1.6 (95% CI, 1.1-2.3; P<.001) and 2.8 ±1.7 (95% CI, 2.1-3.4; P<.002), respectively. However, patients receiving OMT showed a significantly greater reduction in pain intensity compared with those receiving ketorolac (95% CI, 0.2-1.9; P=.02).¹⁷

Otitis media
One study examined the role of OMT in children who had experienced 3 episodes of acute otitis media (AOM) in the 6 months before study enrollment, or 4 episodes in the prior 12 months. Fifty-seven children ages 6 months to 6 years were randomized to receive usual care or usual care plus 7 OMT sessions over 6 months. The OMT group showed a significantly reduced number of AOM episodes and reduced referral for myringotomy/ ventilation tube placement compared with the control group. Additionally, final tympanograms showed an increased frequency of more normal tympanogram types in the OMT group (95% CI, 0.08-1.02; P=.02).¹⁸

Pediatric asthma
Using the registry of an asthma clinic, 1 study selected 140 subjects ages 5 to 17 years and randomized them to receive 1 OMT or 1 sham session, with peak expiratory flows (PEF) measured before and after treatment. The OMT group showed a significant mean increase in PEF from 364 to 377 L/min (95% CI, 7.3-18.7) compared with no change in the sham group.¹⁹

In the same year (2005), a Cochrane review analyzed 3 previous trials including 156 children and adults and found no significant difference in lung function measures with OMT or other manipulative or sham treatments.²⁰

Infantile colic
One study randomized 28 infants ages 1 to 12 weeks diagnosed with colic to receive 4 weekly OMT sessions or no treatment. At 4 weeks’ follow-up, the OMT group showed a significant reduction in parent-reported daily number of hours their infants spent crying, from 2.39 to 0.89 hours (P<.001), and a significant increase in the daily number of hours infants spent sleeping, from 11.55 to 12.9 hours (P<.002). The control group showed a nonsignificant reduction in daily number of hours infants spent crying, from 2.06 to 1.56 hours, and a nonsignificant increase in daily number of hours spent sleeping, from 11.86 to 12.04 hours.²¹