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The Effect of OMM on Opioid Users with Chronic Low Back Pain

Journal: Journal of Osteopathic Medicine Date: 2019/12, 119(12):Pages: e108-e109. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2019.128/html)

Keywords:

chronic pain [204]
drugs [17]
low back pain [413]
OMT [2951]
opioids [32]
osteopathic manipulative treatment [2973]
randomized controlled trial [710]

Abstract:

Statement of Significance: Since chronic pain is sustained by noxious sensory input originating in the musculoskeletal system, it becomes a major target for osteopathic practices. OMM may provide the balance that these patients seek between advanced interventions and patient-centered care, to reduce costs and make safer opioid therapy decisions. Previous studies have explored the use of complementary and alternative medicine (CAM) therapies, and other studies have shown an association between OMM and circulatory pain biomarkers, such as the endogenous opioid system by β-endorphin (βE). However, any significant association of these changes to a therapeutic effect from OMM remains speculative, due to the lack of large sample sizes and controlled prospective designs. Methods: IRB approval was granted for this project (Pro #: 2018002374). In this randomized controlled trial, we approached 273 patients at the NeuroMusculoskeletal Institute in Stratford, New Jersey, who were on opioid therapy for chronic low back pain; overall, 95 patients initially enrolled in the study: treatment group=55, control group=40. The participants were randomized into 2 groups: the treatment group (OMM treatment + opioid therapy) and control group (opioid therapy). After participant attrition, there were a total of 55 participants who completed the study: treatment group=24, control group=31. The OMM treatment modalities consisted of the following: soft tissue, muscle energy (ME), myofascial release (MFR), balanced ligamentous tension (BLT), and counterstrain (CS). To assess the effectiveness of the treatment, patients in both groups filled out 2 forms after each visit, approximately every 4-6 weeks for 3-6 months. The Wong-Baker FACES Pain Rating Scale evaluated the intensity of pain, with scores from 0 to 10. The Pain and Disability Questionnaire (PDQ) measured the disability caused by pain with 2 components: the functional (max score 90) and the psychosocial component (max score 60), for a maximum score of 150 (highest disability). Data from the electronic medical records (EMRs) and New Jersey medical prescription (NJRx) database helped identify and track opioid usage in milligram morphine equivalents (MME) throughout the protocol. Data Analysis: Analysis included paired t tests measuring the pre-study vs poststudy values for the following dependent variables: PDQ functional component, PDQ psychosocial component, FACES pain scale, and MME dosages. t tests analyzed the data in the treatment group and control group independently; the correlation, degrees of freedom, and P value (significance level of .05) were recorded in each respective group. Possible age and gender effects were tested for and did not contribute any significant variance in either group. Results: Paired t tests in the treatment group indicated that there was a trend for decreases in both the PDQ psychosocial component and the FACES pain scale during pre-study vs poststudy, with P values of .05 and .04 respectively. PDQ psychosocial values changed from 45.0 +/- 13.2 to 40.7 +/- 14.7. FACES pain scale values changed from 7.0 +/- 1.7 to 5.75 +/- 2.33. In addition, there was a decreasing trend in the PDQ functional scores for the control group with a P=.03. PDQ functional values changed from 62.5 +/- 17.5 to 59.5 +/- 18.0. There were no significant changes in the MME dosages in either group. Conclusion: The overall results show that OMM intervention may have an impact on the patients’ pain and psychosocial health, due to its hands-on approach and emotional impact. Because there were a high number of patients unable to complete the study in the treatment group, the impact of OMM on physical functioning could not significantly be concluded. Additionally, there needs to be a more effective way to measure the patients’ medication intake in a controlled manner. Physicians can incorporate subjective feedback on pill count and frequency during each encounter, rather than solely an objective MME analysis from the medical prescription database. Suggestions for future research include using OMM intervention every 2 weeks over a longer period of time (6 months), substituting the PDQ with the Roland-Morris Disability questionnaire for low back pain, and adding a poststudy survey for patient feedback.


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