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The Somatic Connection  |   May 2018
Biopsychosocial Effects of Osteopathic Interventions in Patients With Chronic Pain
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine, Pomona, California 
Article Information
The Somatic Connection   |   May 2018
Biopsychosocial Effects of Osteopathic Interventions in Patients With Chronic Pain
The Journal of the American Osteopathic Association, May 2018, Vol. 118, 345-346. doi:10.7556/jaoa.2018.067
The Journal of the American Osteopathic Association, May 2018, Vol. 118, 345-346. doi:10.7556/jaoa.2018.067
Web of Science® Times Cited: 1
Saracutu M, Rance J, Davies H, Edwards DJ. The effects of osteopathic treatment on psychosocial factors in people with persistent pain: a systematic review [published online October 13, 2017]. Int J Osteopath Med. 2018;27:23-33. doi:10.1016/j.ijosm.2017.10.005 
There is a paucity of research investigating the psychological effects of osteopathic manipulative therapy (manipulative care provide by foreign-trained osteopaths) or osteopathic manipulative treatment in patients with chronic pain. Researchers in the United Kingdom performed a systematic review of the effects of osteopathic manual treatment (defined as “osteopathic manual therapy, osteopathic manipulation, mobilization, spinal manipulation, high velocity and low amplitude manipulation, massage, and soft tissue treatment”) on various biopsychosocial factors in patients with chronic pain. Studies were included if they were English-language randomized controlled trials published in peer-reviewed scientific literature between 1980 and 2017 that studied the effects of osteopathic interventions on at least 1 biopsychosocial factor (depression, anxiety, avoidance, catastrophizing, acceptance, and/or self-efficacy) in adult patients with heterogeneous persistent pain conditions. Exclusion criteria were reports of pelvic postpartum pain or pain from a visceral source (eg, irritable bowel syndrome, gout). Of the 862 abstracts retrieved from 7 databases, 16 articles met the inclusion criteria. One study was removed from the final analysis after a quality assessment revealed low quality. The control groups received either standard care, placebo (eg, sham therapy), specific modalities (eg, nonthrust manipulation), nonspecific exercises, or a multimodal program (eg, cognitive behavioral therapy and education, The Back Book and exercise). 
Of the 5 trials that evaluated depression, 2 found significant differences. One found that patients with comorbid depression responded favorably to cervical manipulative therapy, as assessed by the Beck Depression Inventory at 1-year follow-up (P<.0005). All 4 trials assessing anxiety found significant differences related to osteopathic intervention (P<.0005 to P<.041). Of the 3 trials evaluating fear avoidance, 2 found significant decreases in fear avoidance after manipulative intervention (P<.001 and P<.05). One of these 2 studies noted that this finding was only observed in the group that received manipulation followed by an exercise regimen, while no significant change was noted in the manipulation-only group. The study that evaluated pain catastrophizing found a significant association between pain sensitivity in patients who received spinal manual therapy (P<.02). Among the 7 studies assessing health-related quality of life, 5 found significant postintervention improvements (P<.001 to P<.043). Among the 4 trials reporting quality of life, 3 found significant improvements among the intervention groups (P<.001 to P<.05). 
The study was limited by the heterogeneous patient populations and overall poor quality of data reviewed. The pain conditions varied (ie, back pain, neck pain, shoulder pain), as did the age and sex of participants sampled. For example, among the UK BEAM,1 Moustafa et al,2 and Castro-Sanchez et al3 trials, the mean age differed from 43 to 52.5 years, and the percentage of male participants ranged from 4.6% to 57%. Nevertheless, the results suggest that osteopathic interventions may positively affect the biopsychosocial factors related to patients with chronic pain. More work is needed to appraise outcomes, and standardized tools for biopsychosocial assessment should be integrated into all studies of osteopathic interventions and pain. 
References
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. Br Med J. 2004;329(7479):1377. doi: 10.1136/bmj.38282.669225.ae [CrossRef]
Moustafa IM, Diab AA. The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatol Int. 2015;35(7):1163-1174. doi: 10.1007/s00296-015-3248-7 [CrossRef] [PubMed]
Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561753. doi: 10.1155/2011/561753 [PubMed]