Pain

Osteopathic treatment ‘likely not clinically meaningful’ for low back pain


Osteopathic manipulative treatment (OMT) offers some benefit for patients with nonspecific low back pain (LBP) when compared with sham OMT, but that benefit is limited and its clinical relevance calls the intervention into question, according to a new randomised trial.

Previous research had supported the idea that OMT might offer improvements in pain and activity limitations, study lead author Dr Christelle Nguyen, of Centre-Université de Paris, told the limbic. But randomised comparisons with sham treatment were lacking, and it was unclear the extent of the benefit.

In the new trial, published in JAMA Internal Medicine, a total of 400 patients were randomised evenly to receive either OMT or sham OMT over six sessions. The mean duration of patients’ current LBP episode was 7.5 months.

There was a better reduction in LBP-specific activity limitations at three months with OMT. As measured by the Quebec Back Pain Disability Index, the mean reduction with OMT was -4.7, compared with -1.3 with sham OMT (p = .01). That benefit persisted at 12 months from randomisation as well (p = .01).

Seventeen of 164 evaluable patients in the OMT group had at least a 20 point improvement, compared with 12 of 158 evaluable patients in the sham group, though this difference was not significant.

Other outcomes were no different between the groups. This included reduction in pain, mean improvement in health-related quality of life, self-reported number and duration of sick leaves and of LBP episodes, and self-reported consumption of analgesics and nonsteroidal anti-inflammatory drugs.

“That we did not observe any improvements in pain was a bit surprising,” Dr Nguyen told the limbic. “One may assume that in our population, non-specific effects of OMT had a greater impact on activity limitations than on other outcomes, because activity limitations include more dimensions than pain intensity.”

She added that they were not at all surprised by the results, given the state of research on the topic beforehand. The authors concluded that the usefulness of OMT in people with nonspecific LBP is now in question, though there may still be avenues to investigate.

“In our study, some participants seem to be better responders to OMT than others,” Dr Nguyen said. “Further research may focus on identifying and describing this subset of patients.”

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