Manual Osteopathy and Chronic Pain

Chronic pain is pain that lasts more than 3 months or past the time of normal healing, therefore emphasizing the transition from acute injury pain to a persistent chronic pain syndrome. Changes in the peripheral and central nervous system and biopsychosocial factors perpetuate chronic pain. Often occurring after musculoskeletal damage and healing, chronic pain is a redundant signal that serves no biologically useful purpose. Over time, chronic pain can set in motion a self-perpetuating chronic pain syndrome.

Chronic pain syndrome is  closely linked  to somatic dysfunction. Although structure  and function issues may trigger the initial report of pain, homeostatic dysfunctions and  the disruption  of autonomic nervous system may worsen and perpetuate pain perception and distress. Moreover, emotions are often linked to musculoskeletal sensations, thus further dysregulating immune, neurologic, and endocrine systems. This breakdown in homeostasis is seen psychologically  as pain-related fear, depression, anxiety, and decreased quality of life. Chronic pain eventually causes  brain and nervous system reorganization and self perpetuating neural activity.

According to osteopathic philosophy, chronic pain can upset the biopsychosocial balance. Chronic pain is often maintained by noxious sensory input originating in the musculoskeletal system, making it a prime target for osteopathic interventions. In addition, chronic pain creates a sustained autonomic nervous system arousal, elevated cortisol levels, and a prolonged “fight or flight” response. Patients can eventually become exhausted and present symptoms of depression, insomnia, fatigue, guarding muscles, and fear of movement.

Manual osteopathy can be recommended as an option for the management of chronic pain. Physical examination is normally focused on somatic dysfunction, the biological pain generator, and what can be done to help the patient. The effectiveness of manual osteopathy for treating chronic pain is validated by clinical research.

In fact, the largest and most rigorous randomized controlled trial on osteopathic manual treatment (OMT), the OSTEOPAThic Health outcomes In Chronic low back pain Trial, was published in 2013. It used a randomized, double-blind, sham-controlled, 2 × 2 factorial design to study OMT for patients with chronic low back pain (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; osteoarticulatory; 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 low back pain improvement in patients with high baseline pain severity. Clinically important improvement in back-specific functioning was also found in the OMT group compared with that in the sham OMT group. The findings of this study suggest that OMT could be an excellent adjunct to the care of patients with severe chronic LBP.