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Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials

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The objective of this systematic review was to assess the effectiveness of osteopathy as a treatment option for musculoskeletal pain. Six databases were searched from their inception to August 2010. Only randomized clinical trials (RCTs) were considered if they tested osteopathic manipulation/mobilization against any control intervention or no therapy in human with any musculoskeletal pain in any anatomical location, and if they assessed pain as an outcome measure. The selection of studies, data extraction, and validation were performed independently by two reviewers. Studies of chiropractic manipulations were excluded. Sixteen RCTs met the inclusion criteria. Their methodological quality ranged between 1 and 4 on the Jadad scale (max = 5). Five RCTs suggested that osteopathy compared to various control interventions leads to a significantly stronger reduction of musculoskeletal pain. Eleven RCTs indicated that osteopathy compared to controls generates no change in musculoskeletal pain. Collectively, these data fail to produce compelling evidence for the effectiveness of osteopathy as a treatment of musculoskeletal pain.

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  1. Foster NE, Pincus T, Underwood MR, Vogel S, Breen A, Harding G (2003) Understanding the process of care for musculoskeletal conditions—why a biomedical approach is inadequate. Rheumatol (Oxf) 42(3):401–404

    CAS  Google Scholar 

  2. Jordan JL, Holden MA, Mason EE, Foster NE (2010) Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev (1):CD005956

  3. White KP, Harth M (1999) The occurrence and impact of generalised pain. Baillières Clin Rheumatol 13:379–389

    Article  CAS  Google Scholar 

  4. Wijnhoven HA, de Vet HC, Picavet HS (2006) Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain 22(8):717–724

    Article  PubMed  Google Scholar 

  5. Wijnhoven HA, de Vet HC, Picavet HS (2006) Explaining sex differences in chronic musculoskeletal pain in a general population. Pain 124(1–2):158–166

    Article  PubMed  Google Scholar 

  6. Picavet HS, Schouten JS (2003) Musculoskeletal pain in the Netherlands: prevalence, consequences and risk groups, the DMC(3)-study. Pain 102(1–2):167–178

    Article  CAS  PubMed  Google Scholar 

  7. Licciardone JC, Brimhall AK, King LN (2005) Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 6:43

    Article  PubMed  Google Scholar 

  8. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomised clinical trials: is blinding necessary. Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  9. Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S (1999) A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med 341(19):1426–1431

    Article  CAS  PubMed  Google Scholar 

  10. Eisenhart AW, Gaeta TJ, Yens DP (2003) Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc 103(9):417–421

    PubMed  Google Scholar 

  11. Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR (2002) Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc 102(6):321–325

    PubMed  Google Scholar 

  12. Knebl JA, Shores JH, Gamber RG, Gray WT, Herron KM (2002) Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized, controlled trial. J Am Osteopath Assoc 102(7):387–396

    PubMed  Google Scholar 

  13. Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr (2003) Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine 28(13):1355–1362

    Article  PubMed  Google Scholar 

  14. Licciardone JC, Stoll ST, Cardarelli KM, Gamber RG, Swift JN Jr, Winn WB (2004) A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty. J Am Osteopath Assoc 104(5):193–202

    PubMed  Google Scholar 

  15. McReynolds TM, Sheridan BJ (2005) Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc 105(2):57–68

    PubMed  Google Scholar 

  16. Geldschläger S (2004) Osteopathic versus orthopedic treatments for chronic epicondylopathia humeri radialis: a randomized controlled trial. Forsch Komplementärmed Klass Naturheilkd 11(2):93–97

    Article  PubMed  Google Scholar 

  17. Schwerla F, Bischoff A, Nurnberger A, Genter P, Guillaume JP, Resch KL (2008) Osteopathic treatment of patients with chronic non-specific neck pain: a randomised controlled trial of efficacy. Forsch Komplementmed 15(3):138–145

    Article  PubMed  Google Scholar 

  18. Cuccia AM, Caradonna C, Annunziata V, Caradonna D (2010) Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther 14(2):179–184, Epub 2009 Sep 20

    Article  CAS  PubMed  Google Scholar 

  19. Fryer GA, Mudge JM, McLaughlin PA (2002) The effect of talocrural joint manipulation on range of motion at the ankle. J Manipulative Physiol Ther 25(6):384–390

    Article  PubMed  Google Scholar 

  20. Martínez-Segura R, Fernández-de-las-Peñas C, Ruiz-Sáez M, López-Jiménez C, Rodríguez-Blanco C (2006) Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. J Manipulative Physiol Ther 29(7):511–517

    Article  PubMed  Google Scholar 

  21. Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, Muntz R (2003) Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract 20(6):662–669

    Article  PubMed  Google Scholar 

  22. Burton AK, Tillotson KM, Cleary J (2000) Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J 9(3):202–207

    Article  CAS  PubMed  Google Scholar 

  23. Chown M, Whittamore L, Rushb M, Allan S, Stott D, Archer M (2008) A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy. Physiotherapy 94:21–28

    Article  Google Scholar 

  24. Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R (1985) Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet 1(8440):1258–1261

    Article  CAS  PubMed  Google Scholar 

  25. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK (2007) Clinical efficacy assessment subcommittee of the American college of physicians; American college of physicians; American pain society low back pain guidelines panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American college of physicians and the American pain society. Ann Intern Med 147(7):478–491, Erratum in: Ann Intern Med. 2008 Feb 5;148(3):247–248

    PubMed  Google Scholar 

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Correspondence to Paul Posadzki.

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Posadzki, P., Ernst, E. Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials. Clin Rheumatol 30, 285–291 (2011).

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