Osteopathic Medicine Approach to Pain Management

11 Jun

With a holistic approach to patient care—encompassing the integration of structure and function, emotional and social aspects of health and healing, and a more heuristic biopsychosocial approach to pain assessment and management—osteopathic physicians are uniquely positioned to manage patients with chronic pain.

OMT is the “hands on” use of force in response to somatic dysfunction in the body. The goal of OMT is to correct, remove or improve somatic dysfunction thereby allowing for the body’s self-healing, self-regulating (i.e., homeostatic) mechanisms to become more effective at restoring health. This is an example of the application of the structure-function principle. A retrospective study of 1,331 consecutive patient encounters in a primary care setting demonstrates that osteopathic practitioners commonly document soma-tic dysfunction, treat it with OMT, and record resolution or improvement in virtually all patients.19 OMT consists of a wide variety of techniques, ranging from direct (into the restrictive barrier) such as high velocity/low amplitude thrust and muscle energy techniques, to indirect (away from the restrictive barrier) such as myofascial release and counter-strain techniques. Some of the more controversial techniques comprise osteopathy in the cranial field. This group of techniques rely on the body’s inherent “primary respiratory mechanism” in conjunction with “balanced membranous tension” to affect change at the body’s intercellular level.20 This is primarily accomplished by treating the bony and membranous structures of the head which, in turn, influence the cerebrospinal fluid and the neurological centers located in proximity to the fourth ventricle.20 These techniques are most commonly associated with treatment of the cranium and sacrum but can be performed on any part of the body. They are theorized to have an effect on the body’s autonomic control centers. It is the skill and expertise of the treating osteopathic physician, as well as the patient’s history, that determine the appropriate technique to use. 

The goal of OMT is not necessarily to remove pain but to restore function to the dysfunctional structures and allow the body’s own self-healing mechanisms to resolve the pain. Perhaps unique to the osteopathic treatment of painful conditions is this emphasis on improving function rather removing or resolving pain during a treatment. It is more common for a patient to have palpably significant changes in the function and structures of the areas treated, and only have partial reduction in pain immediately after treatment—followed by several days of continued improvement in pain post-treatment. For example, in the randomized controlled trial of OMT during third trimester pregnancy, the OMT group not only demonstrated a statistical trend toward decreased pain but also experienced significantly better functional outcomes than the control groups.17

OMT is extremely safe, with the most common adverse effects being temporary soreness and aching during the first 24 to 48 hours following treatment. Less than 10% of patients attending an OMM specialty clinic reported any adverse effect from OMT and any adverse effects, when observed, did not negatively impact clinical outcomes or patient satisfaction.21 Serious adverse events, such as vertebral artery dissections and disk herniations—occur extremely rarely during manual interventions of any type.22 A study of non-osteopathic manual therapies has shown that such serious adverse events are associated with more aggressive direct, or thrust, techniques.23

 

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