Licciardone JC, Gatchel RJ. Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study. J Am Osteopath Assoc 2020;120(2):64–73. doi: https://doi.org/10.7556/jaoa.2020.016.
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The OSTEOPATHIC Trial demonstrated substantial improvement in pain intensity, decreased need for rescue medication for pain, and greater likelihood of recovery in patients with chronic low back pain who received 6 osteopathic manipulative treatment (OMT) sessions over 3 months.
To assess osteopathic medical care and the effectiveness of OMT for chronic low back pain in a real-world setting without the constraints of a rigid research protocol.
An observational study of 445 adults with chronic low back pain who had an established osteopathic physician (ie, DO) or allopathic physician (ie, MD) was conducted within the PRECISION Pain Research Registry from April 2016 through February 2019. Primary outcome measures included a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related functioning, and use of nonsteroidal anti-inflammatory drugs or opioids for low back pain.
A total of 79, 48, and 318 patients, respectively, were treated by DOs who used OMT, DOs who did not use OMT, or MDs. Patients treated by DOs who used OMT reported significantly lesser low back pain intensity (mean numerical rating score, 5.6; 95% CI, 5.1-6.1 vs 6.1; 95% CI, 5.9-6.3; P=.04) and back-related disability (mean Roland-Morris Disability score, 12.4; 95% CI, 11.1-13.8 vs 14.4; 95% CI, 13.7-15.0; P=.009) than patients treated by MDs. Patients treated by DOs who used OMT also reported less frequent use of nonsteroidal anti-inflammatory drugs (multivariate odds ratio, 0.41; 95% CI, 0.24-0.70; P=.001) or opioids (multivariate odds ratio, 0.52; 95% CI, 0.28-0.98; P=.04). There were no significant differences in primary outcomes between DOs who did not use OMT and MDs.
This study of community-based patients in a pain research registry supports the effectiveness of OMT as an integral component of osteopathic medical care for chronic low back pain. Patients treated by DOs who did not use OMT did not experience better results than patients treated by MDs in any primary outcome measure. Further research is needed to more specifically compare the effects of OMT with other treatment effects that may be attributed to patient-DO interactions during medical encounters.
a Data are given as No. (%) unless otherwise indicated.
b Higher scores on the SPADE cluster represent poorer quality of life.
Abbreviations: DO, osteopathic physician; MD, allopathic physician; NSAID, nonsteroidal anti-inflammatory drug; OMT, osteopathic manipulative treatment; SPADE, sleep disturbance, pain interference with activities, anxiety, depression, low energy/fatigue.
a Odds ratios (ORs) and 95% CIs were computed using multiple logistic regression for current use of nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. Age, low back pain intensity, and back-related disability were entered as covariates in these models, with the ORs and 95% CIs for these variables representing each unit increase in age (y), numerical rating scale score, and Roland-Morris Disability score, respectively.
Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.
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