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The Somatic Connection  |   January 2014
OMT Relieves Severe Chronic Low Back Pain
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   January 2014
OMT Relieves Severe Chronic Low Back Pain
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 60-61. doi:10.7556/jaoa.2014.009
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 60-61. doi:10.7556/jaoa.2014.009
Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial [published online December 2013]. Man Ther. 2013;18(6):533-540. doi:10.1016/j.math.2013.05.006.  
The largest and most rigorous randomized controlled trial on osteopathic manual treatment (more commonly known as osteopathic manipulative treatment [OMT]), the OSTEOPAThic Health outcomes In Chronic low back pain Trial, was published in 2013.1 It used a randomized, double-blind, sham-controlled, 2 × 2 factorial design to study OMT for patients with chronic low back pain (LBP). The Journal of the American Osteopathic Association published 4 subgroup analyses of this historic trial.2-5 Another subgroup analysis from this trial, recently published in Manual Therapy, reported the effectiveness of OMT according to baseline severity of chronic LBP. 
A total of 455 participants were divided into 2 categories: those who reported low baseline pain severity (<50 mm on a 100-mm visual analog scale; 269 participants [59%]) and those who reported high baseline pain severity (⩾50 mm on a 100-mm visual analog scale; 186 participants [41%]). Six 15-minute OMT sessions were provided every 2 weeks by the same trained osteopathic physician over 8 weeks. Outcomes were assessed at week 12. The provided OMT techniques included high-velocity, low-amplitude; articulatory; soft tissue; myofascial stretching and release; strain-counterstrain; and muscle energy. Sham OMT included active and passive range of motion, light touch, improper patient positioning, purposely misdirected movements, and diminished force. 
The study revealed a large effect size for OMT vs sham OMT in providing substantial LBP improvement in patients with high baseline pain severity (response ratio, 2.04; 95% confidence interval, 1.36-3.05; P<.001). Clinically important improvement in back-specific functioning was also found in the OMT group compared with that in the sham OMT group (response ratio, 1.80; 95% confidence interval, 1.08-3.01; P⩽.02). The findings of this study suggest that OMT would be an excellent adjunct to the care of patients with severe chronic LBP. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
 
   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (mseffingerdo@osteopathic.org), or JAOA Editorial Advisory Board Member Hollis H. King, DO, PhD (hollis.king@fammed.wisc.edu).
 
References
Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med. 2013;11(2):122-129. doi:10.1370/afm.1468. [CrossRef] [PubMed]
Licciardone JC, Kearns CM. Somatic dysfunction and its association with chronic low back pain, back-specific functioning, and general health: results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2012;112(7):420-428. [PubMed]
Licciardone JC, Kearns CM, Hodge LM, Bergamini MV. Associations of cytokine concentrations with key osteopathic lesions and clinical outcomes in patients with nonspecific chronic low back pain: results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2012;112(9):596-605. [PubMed]
Licciardone JC, Gatchel RJ, Kearns CM, Minotti DE. Depression, somatization, and somatic dysfunction in patients with nonspecific chronic low back pain: results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2012;112(12):783-791. [PubMed]
Licciardone JC, Kearns CM, Hodge LM, Minotti DE. Osteopathic manual treatment in patients with diabetes mellitus and comorbid chronic low back pain: subgroup results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2013;113(6):468-478. [PubMed]