The effects of osteopathic manipulative treatment on pain and disability in patients with chronic neck pain: A single-blinded randomized controlled trial.

The short version

This single-blinded, cross-over randomized controlled trial with 97 adults explored whether osteopathic manipulative treatment (OMT), a hands-on approach in which physicians assess and treat restrictions in joint and soft-tissue movement, reduces pain and disability in chronic, nonspecific neck pain (pain lasting at least three months with no serious underlying disease). Neck pain is common, affecting up to 70% of people at some point in life, and systematic reviews describe manual treatment as moderately effective, but only three earlier randomized trials had tested OMT for chronic neck pain. The trial, run at a university osteopathic clinic in Michigan and registered as NCT02261259, compared OMT with a waiting period. Participants were 21 to 65 years old and had lived with neck pain for more than eight years on average. They were assigned 1:1 to receive OMT straight away or to wait first. The OMT group had three to four sessions of about 30 minutes over four to six weeks, with osteopathic physicians choosing techniques such as a quick cervical thrust, muscle energy (the patient contracts a muscle against resistance), myofascial and joint-articulation work. Pain was rated from 0 to 10, disability was scored on the Neck Disability Index, and sleep, fatigue and mood were measured with PROMIS-29 questionnaires. Compared with waiting, OMT lowered average pain by 1.02 points (95% CI -1.72 to -0.32, p = 0.005; about a one-point drop on the 0-10 scale) and current pain by 1.02 points (p = 0.006). Disability fell by 5.3 percentage points more on the Neck Disability Index (p = 0.010). Sleep disturbance (-3.25, p = 0.003), fatigue (-3.26, p = 0.022) and depression scores (-2.59, p = 0.018) also improved more after OMT, with effect sizes of 0.5 to 1 standard deviation, a range the authors regard as clinically meaningful. Some benefit persisted after the groups switched, which is why only the first stage was compared. Of 187 adverse events recorded, none was serious; 37 were linked to the 298 OMT sessions (12%) and were mostly increased neck pain (16) or muscle soreness (15), with one severe rib-pain flare. The authors conclude that OMT was relatively safe and improved pain, disability, sleep, fatigue and depression right after four to six weeks of treatment. Limitations include no long-term follow-up, a waiting-period rather than sham or active control, a single center, 23% attrition counting dropouts before baseline, and recruitment of people not necessarily seeking care. The study was originally designed to validate head-neck motor control tests, so it had no active comparison treatment. The authors propose larger multicenter trials with longer follow-up to confirm the findings.

Key findings

• A randomized trial of 97 adults with chronic nonspecific neck pain found that osteopathic manipulative treatment (OMT, hands-on joint and soft-tissue techniques) reduced average pain by 1.02 points on a 0-10 scale compared with waiting (p = 0.005).
• Neck-related disability (measured with the Neck Disability Index) fell by 5.3 percentage points more in the OMT group, and sleep disturbance, fatigue and depression scores also improved.
• Of 298 OMT sessions, 37 (12%) were followed by an expected adverse event such as increased neck pain or muscle soreness; none was serious.
• The comparison group was an untreated waiting period rather than a sham treatment, and results beyond about five weeks were not analyzed because of carryover, so durability and placebo effects remain untested.

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