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Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial.

ABSTRACT: We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain.A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12 (30% or greater and 50% or greater pain reductions from baseline, respectively). Five secondary outcomes, safety, and treatment adherence were also assessed.There was no statistical interaction between OMT and UST. Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate (response ratio [RR] = 1.38; 95% CI, 1.16-1.64; P <.001) and substantial (RR = 1.41, 95% CI, 1.13-1.76; P = .002) improvements in low back pain at week 12. These improvements met the Cochrane Back Review Group criterion for a medium effect size. Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT. Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study (P <.001). Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group (use ratio = 0.66, 95% CI, 0.43-1.00; P = .048). Ultrasound therapy was not efficacious.The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.

SUBMITTER: Licciardone JC

PROVIDER: S-EPMC3601389 | biostudies-literature | 2013 Mar-Apr

REPOSITORIES: biostudies-literature

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Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial.

Licciardone John C JC Minotti Dennis E DE Gatchel Robert J RJ Kearns Cathleen M CM Singh Karan P KP

Annals of family medicine 20130301 2

<h4>Purpose</h4>We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain.<h4>Methods</h4>A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided ...[more]

PMID: 23508598

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Project description:Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain.Computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen's d statistic and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, stratified meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and stratified meta-analyses.Overall, OMT significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 - -0.13; P = .001). Stratified analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, intermediate-, and long-term follow-up.OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

Project description:BackgroundNon-specific chronic low back pain (NSCLBP) refers to a complex condition that involves structural, biomechanical, cognitive, psychological, social, and lifestyle issues. First-line therapies include physical therapy and exercise, as well as psychological follow-up and pain medication.AimThe aim of this study was to assess the impact of a 6-week center-based program using a multi-axis motorized platform (HUBER) connected with force sensors, that allows the patients to execute isometric exercises on the spine flexion-to-extension ratio at 60 and 120°/s, pain, trunk flexibility, and disability.DesignThe design of the study was prospective, active control, parallel-group, assessor-blinded, randomized controlled trial.SettingThe setting was outpatients physical therapy clinic.PopulationThe population analyzed presented NSCLBP.MethodsSeventy individuals with NSCLBP were randomized into 2 intervention arms (1:1 ratio): 1/standard rehabilitation group (STAND) with physiotherapy, balneotherapy and cycloergometer exercises and 2/HUBER rehabilitation group (HUB) with physiotherapy, balneotherapy and HUBER exercises. Both programs lasted 6 weeks, with 4 sessions of 2 hours each per week.ResultsEach group reported statistically significant improvements on the isokinetic spine strength, flexibility of the trunk, lumbar joint mobility, muscular endurance of the trunk and of the lower limbs, pain score and disability (P<0.05). The spine flexion/extension ratio at 60˚/s improved similarly between groups (-22.23 for HUB, and -13.04 for STAND; P=0.178) with a greater effect size in HUB. Only HUB reported a significant improvement in the spine flexion-to-extension ratio at 120˚/s (from 87.3 to 78.6, P=0.012). HUB reported a greater decrease in the Oswestry Disability Index (-16.83) compared to STAND (-12.11), with a statistically significant effect between groups (P=0.036).ConclusionsExercises performed on the HUBER platform added to physiotherapy and balneotherapy are as effective as a standard rehabilitation program with physiotherapy, balneotherapy and cycloergometer exercises to improve isokinetic spine strength, lumbar joint mobility, flexibility and muscular endurance of the trunk and the lower limbs. In addition, exercising with the HUBER platform result in a greater reduction in disability compared to a standard rehabilitation program (clinicalTrials.gov: NCT05437016).Clinical rehabilitation impactA variety of intervention techniques, including supervised exercise and manual therapy are now used to manage persistent NSCLBP. The added value of the HUBER device on disability suggests that the platform could be beneficial.

Project description:Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging. Fifteen cLBP patients and 16 healthy control (HC) subjects were scanned while observing and rating video clips depicting back-straining or neutral physical exercises, which they knew they would have to perform at the end of the visit. This task was repeated after a single session of spinal manipulation (cLBP and HC group) or mobilization (cLBP group only), in separate visits. Compared with HC subjects, cLBP patients reported higher expected pain and fear of performing the observed exercises. These ratings, along with clinical pain, were reduced by SMT. Moreover, cLBP, relative to HC subjects, demonstrated higher blood oxygen level-dependent signal in brain circuitry that has previously been implicated in salience, social cognition, and mentalizing, while observing back straining compared with neutral exercises. The engagement of this circuitry was reduced after SMT, and especially the spinal manipulation session, proportionally to the magnitude of SMT-induced reduction in anticipated pain and fear. This study sheds light on the brain processing of anticipated pain and fear of back-straining movement in cLBP, and suggests that SMT may reduce cognitive and affective-motivational aspects of fear-avoidance behavior, along with corresponding brain processes. PERSPECTIVE: This study of cLBP patients investigated how SMT affects clinical pain, expected pain, and fear of physical exercises. The results indicate that one of the mechanisms of SMT may be to reduce pain expectancy, fear of movement, and associated brain responses.

Project description:BackgroundPatients with chronic low back pain (CLBP) suffer with functional, social, and psychological aspects. There is a growing number of studies with multimodal approaches in the management of these patients, combining physical and behavioral therapies such as osteopathic manipulative treatment, associating pain education and clinical hypnosis. The aim of the present study will be to evaluate the effects of osteopathic manipulative treatment (OMT) associated with pain neuroscience education (PNE) and clinical hypnosis (CH) on pain and disability in participants with CLBP compared to PNE, CH, and sham therapy.MethodsA randomized controlled clinical trial will be conducted in participants aged 20-60 years with CLBP who will be divided into two groups. Group 1 will receive PNE and CH associated with OMT, and G2 will receive PNE, CH, and sham therapy. In both groups, 4 interventions of a maximum of 50 min and with an interval of 7 days will be performed. As primary outcomes, pain (numerical pain scale), pressure pain threshold (pressure algometer), and disability (Oswestry Disability Questionnaire) will be evaluated and, as a secondary outcome, global impression of improvement (Percent of Improvement Scale), central sensitization (Central Sensitization Questionnaire), biopsychosocial aspects (Start Beck Toll Questionnaire), and behavior of the autonomic nervous system (heart rate variability) will be assessed. Participants will be evaluated in the pre-intervention moments, immediately after the end of the protocol and 4 weeks after the procedures. Randomization will be created through a simple randomized sequence and the evaluator will be blinded to the allocation of intervention groups.DiscussionThe guidelines have been encouraging multimodal, biopsychosocial approaches for patients with CLBP; in this sense, the results of this study can help clinicians and researchers in the implementation of a model of treatment strategy for these patients. In addition, patients may benefit from approaches with minimal risk of deleterious effects and low cost. In addition, it will enable the addition of relevant elements to the literature, with approaches that interact and do not segment the body and brain of patients with CLBP, allowing new studies in this scenario.Trials registrationDate: September 4, 2021/Number: NCT05042115 .

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Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial.

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Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial.

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