FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 341:1426-1431 November 4, 1999 Number 19 Next

	Full Text PDF Editorial by Howell, J. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Oppenheim, J. S. PubMed Citation

ABSTRACT

Background The effect of osteopathic manual therapy (i.e., spinal manipulation) in patients with chronic and subchronic back pain is largely unknown, and its use in such patients is controversial. Nevertheless, manual therapy is a frequently used method of treatment in this group of patients.

Methods We performed a randomized, controlled trial that involved patients who had had back pain for at least three weeks but less than six months. We screened 1193 patients; 178 were found to be eligible and were randomly assigned to treatment groups; 23 of these patients subsequently dropped out of the study. The patients were treated either with one or more standard medical therapies (72 patients) or with osteopathic manual therapy (83 patients). We used a variety of outcome measures, including scores on the Roland–Morris and Oswestry questionnaires, a visual-analogue pain scale, and measurements of range of motion and straight-leg raising, to assess the results of treatment over a 12-week period.

Results Patients in both groups improved during the 12 weeks. There was no statistically significant difference between the two groups in any of the primary outcome measures. The osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) (P< 0.001) and used less physical therapy (0.2 percent vs. 2.6 percent, P<0.05). More than 90 percent of the patients in both groups were satisfied with their care.

Conclusions Osteopathic manual care and standard medical care have similar clinical results in patients with subacute low back pain. However, the use of medication is greater with standard care.

Source Information

From the Departments of Orthopedic Surgery (G.B.J.A.) and Preventive Medicine (T.L., A.M.D., S.L.), Rush–Presbyterian–St. Luke's Medical Center, Chicago; and Chicago College of Osteopathic Medicine, Downers Grove, Ill. (R.E.K., J.A.L.).

Address reprint requests to Dr. Andersson at the Department of Orthopedic Surgery, Rush–Presbyterian–St. Luke's Medical Center, 1653 W. Congress Pkwy., 1471 Jelke, Chicago, IL 60612, or at ganderss{at}rush.edu.

Full Text of this Article

Related Letters:

Osteopathic Treatment of Low Back Pain
Oppenheim J. S., Cherkin D., Foster D., Johnson M. D., Harrelson A., Sweetman B. J., Rogers F. J., Lyon D. A., Orlando C., Field L., Andersson G. B.J., Howell J. D.
Extract | Full Text  
N Engl J Med 2000; 342:817-820, Mar 16, 2000. Correspondence

This article has been cited by other articles:

• Meltzer, K. R., Standley, P. R. (2007). Modeled Repetitive Motion Strain and Indirect Osteopathic Manipulative Techniques in Regulation of Human Fibroblast Proliferation and Interleukin Secretion. JAOA: Journal of the American Osteopathic Association 107: 527-536 [Abstract] [Full Text]  
• Degenhardt, B. F., Darmani, N. A., Johnson, J. C., Towns, L. C., J. Rhodes, D. C., Trinh, C., McClanahan, B., DiMarzo, V. (2007). Role of Osteopathic Manipulative Treatment in Altering Pain Biomarkers: A Pilot Study. JAOA: Journal of the American Osteopathic Association 107: 387-400 [Abstract] [Full Text]  
• Davis, M. F., Worden, K., Clawson, D., Meaney, F. J., Duncan, B. (2007). Confirmatory Factor Analysis in Osteopathic Medicine: Fascial and Spinal Motion Restrictions as Correlates of Muscle Spasticity in Children With Cerebral Palsy. JAOA: Journal of the American Osteopathic Association 107: 226-232 [Abstract] [Full Text]  
• Leleszi, J. P., Lewandowski, J. G. (2007). Managing Pain in Patients at End of Life. JAOA: Journal of the American Osteopathic Association 107: ES3-ES9 [Abstract] [Full Text]  
• Shen, F. H., Samartzis, D., Andersson, G. B.J. (2006). Nonsurgical Management of Acute and Chronic Low Back Pain. J Am Acad Orthop Surg 14: 477-487 [Abstract] [Full Text]  
• Licciardone, J. C., Russo, D. P. (2006). Blinding Protocols, Treatment Credibility, and Expectancy: Methodologic Issues in Clinical Trials of Osteopathic Manipulative Treatment. JAOA: Journal of the American Osteopathic Association 106: 457-463 [Abstract] [Full Text]  
• MCCOMBS, T. M. (2006). OMT: Evidence, Research, and Practice.. JAOA: Journal of the American Osteopathic Association 106: 379-380 [Full Text]  
• HANSEN, G. P. (2006). Chiropractic Research Equals Osteopathic Research?. JAOA: Journal of the American Osteopathic Association 106: 316-317 [Full Text]  
• HANSEN, G. P. (2006). Beyond OMT: Time for a New Chapter in Osteopathic Medicine?. JAOA: Journal of the American Osteopathic Association 106: 114-116 [Full Text]  
• Dodd, J. G., Good, M. M., Nguyen, T. L., Grigg, A. I., Batia, L. M., Standley, P. R. (2006). In Vitro Biophysical Strain Model for Understanding Mechanisms of Osteopathic Manipulative Treatment. JAOA: Journal of the American Osteopathic Association 106: 157-166 [Abstract] [Full Text]  
• Licciardone, J. C., Nelson, K. E., Glonek, T., Sleszynski, S. L., Cruser, d. A. (2005). Osteopathic Manipulative Treatment of Somatic Dysfunction Among Patients in the Family Practice Clinic Setting: A Retrospective Analysis. JAOA: Journal of the American Osteopathic Association 105: 537-544 [Abstract] [Full Text]  
• Leleszi, J. P., Lewandowski, J. G. (2005). Pain Management in End-of-Life Care. JAOA: Journal of the American Osteopathic Association 105: 6S-11S [Abstract] [Full Text]  
• McReynolds, T. M., Sheridan, B. J. (2005). Intramuscular Ketorolac Versus Osteopathic Manipulative Treatment in the Management of Acute Neck Pain in the Emergency Department: A Randomized Clinical Trial. JAOA: Journal of the American Osteopathic Association 105: 57-68 [Abstract] [Full Text]  
• D'Alonzo, G. E. Jr (2004). Dr Levine's Legacy Lives On: A Tribute to My Mentor, A Humble but Effective Giant. JAOA: Journal of the American Osteopathic Association 104: 519-520 [Full Text]  
• Rubin, B. R. (2004). New Advances in the Treatment of Patients With Pain. JAOA: Journal of the American Osteopathic Association 104: 1S-1S [Full Text]  
• Licciardone, J. C. (2004). The Unique Role of Osteopathic Physicians in Treating Patients With Low Back Pain. JAOA: Journal of the American Osteopathic Association 104: 13S-18S [Abstract] [Full Text]  
• Sleszynski, S. L., Glonek, T., Kuchera, W. A. (2004). Outpatient Osteopathic Single Organ System Musculoskeletal Exam Form Series: Validation of the Outpatient Osteopathic SOS Musculoskeletal Exam Form, a New Standardized Medical Record. JAOA: Journal of the American Osteopathic Association 104: 423-438 [Abstract] [Full Text]  
• Sran, M M (2004). To treat or not to treat: new evidence for the effectiveness of manual therapy. Br. J. Sports. Med. 38: 521-525 [Full Text]  
• Licciardone, J. C., Stoll, S. T., Cardarelli, K. M., Gamber, R. G., Swift, J. N. Jr, Winn, W. B. (2004). A Randomized Controlled Trial of Osteopathic Manipulative Treatment Following Knee or Hip Arthroplasty. JAOA: Journal of the American Osteopathic Association 104: 193-202 [Abstract] [Full Text]  
• Sun, C., Desai, G. J., Pucci, D. S., Jew, S. (2004). Musculoskeletal Disorders: Does the Osteopathic Medical Profession Demonstrate Its Unique and Distinctive Characteristics?. JAOA: Journal of the American Osteopathic Association 104: 149-155 [Abstract] [Full Text]  
• Noll, D. R., Degenhardt, B. F., Stuart, M., McGovern, R., Matteson, M. (2004). Effectiveness of a Sham Protocol and Adverse Effects in a Clinical Trial of Osteopathic Manipulative Treatment in Nursing Home Patients. JAOA: Journal of the American Osteopathic Association 104: 107-113 [Full Text]  
• Assendelft, W. J.J., Morton, S. C., Yu, E. I., Suttorp, M. J., Shekelle, P. G. (2003). Spinal Manipulative Therapy for Low Back Pain: A Meta-Analysis of Effectiveness Relative to Other Therapies. ANN INTERN MED 138: 871-881 [Abstract] [Full Text]  
• Hertzman-Miller, R. P., Morgenstern, H., Hurwitz, E. L., Yu, F., Adams, A. H., Harber, P., Kominski, G. F. (2002). Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive Medical or Chiropractic Care: Results From the UCLA Low-Back Pain Study. Am. J. Public Health 92: 1628-1633 [Abstract] [Full Text]  
• Pengel, H. M, Maher, C. G, Refshauge, K. M (2002). Systematic review of conservative interventions for subacute low back pain. Clin Rehabil 16: 811-820 [Abstract]  
• Meeker, W. C., Haldeman, S. (2002). Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. ANN INTERN MED 136: 216-227 [Abstract] [Full Text]  
• Haig, A. J., Wallbom, A., Hill, P. G., Deyo, R. A., Weinstein, J. N. (2001). Low Back Pain. NEJM 344: 1644-1645 [Full Text]  
• Deyo, R. A., Weinstein, J. N. (2001). Low Back Pain. NEJM 344: 363-370 [Full Text]  
• (2000). Robin Goodfellow. Rheumatology (Oxford) 39: 572-572 [Full Text]  
• Oppenheim, J. S., Cherkin, D., Foster, D., Johnson, M. D., Harrelson, A., Sweetman, B. J., Rogers, F. J., Lyon, D. A., Orlando, C., Field, L., Andersson, G. B.J., Howell, J. D. (2000). Osteopathic Treatment of Low Back Pain. NEJM 342: 817-820 [Full Text]  
• (1999). Osteopathic vs. Standard Care for Low Back Pain. JWatch General 1999: 7-7 [Full Text]  
• Howell, J. D. (1999). The Paradox of Osteopathy. NEJM 341: 1465-1468 [Full Text]