Letters to the Editor  |   April 2008
A.T. Still Would Not Be Proud
Author Affiliations
  • Cory M. Fisher, DO
    Lakewood Medical Associates Rocky River, Ohio
Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment / Pain Management/Palliative Care / Headache
Letters to the Editor   |   April 2008
A.T. Still Would Not Be Proud
The Journal of the American Osteopathic Association, April 2008, Vol. 108, 191. doi:10.7556/jaoa.2008.108.4.191
The Journal of the American Osteopathic Association, April 2008, Vol. 108, 191. doi:10.7556/jaoa.2008.108.4.191
To the Editor:  
Recently, I conducted an Internet search for published articles about osteopathic manipulative treatment (OMT) for patients with migraine headache. Much to my surprise, I found a review article, “Diagnosing and Managing Migraine Headache,” by Loretta L. Mueller, DO, that had been published in the November 2007 supplement to JAOA—The Journal of the American Osteopathic Association (2007;107[suppl 6]:ES10-ES16). What a needle in a haystack! 
In the abstract, Dr Mueller mentioned that OMT “...may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscularautonomic regulatory mechanisms to reduce discomfort from headache.” I had never before heard of the use of OMT to reduce pain input into the trigeminal nucleus caudalis. 
Unfortunately, the grandiose excitement I felt after reading this abstract was surpassed only by my horrific disappointment upon reading the rest of the article. 
The article's overviews of diagnostic criteria and pharmacologic options (the latter likely sponsored by Purdue Pharma LP, the providers of the “educational grant” supporting the publication), as well as the case presentation, were thorough and informative. However, other than a generic blurb noting that “...OMT for paravertebral cervical spasm associated with headaches may be beneficial,” Dr Mueller made absolutely no mention of osteopathic medical considerations within the body of the article. The article did not even provide an explanation of the application of OMT to the trigeminal nucleus caudalis, despite mentioning this concept in the abstract. Isn't the abstract supposed to be a summation of information contained in the body of the article? 
During a time in which most osteopathic physicians are working diligently to refine and showcase the differences between ourselves and our allopathic colleagues, it is very disheartening to read an osteopathically written, edited, and published piece on an osteopathically manageable disease process that makes no mention of somatic dysfunction, muscle energy, high velocity/low amplitude (HVLA) technique, or even cranial-sacral technique. Andrew Taylor Still, MD, DO would not be proud. Although I realize that these techniques may not yet be “evidence based,” does that mean we shouldn't even speak of them in our own journal? 
Thank you, JAOA, for reaffirming the logic of my preference of turning to American Family Physician for my literature searches and continuing medical education. I look forward to 6 months from now, when I may have forgotten about this incident and again test the waters of the JAOA`s Web site.