Opioid crisis renews interest in osteopathic manipulation therapy

Physicians' widespread prescribing of opiate-based pain relievers helped fuel the record number of addicted Americans. Unfortunately, the campaign to significantly reduce opioid prescribing has been hindered by an inability to identify suitable alternatives for managing chronic pain.

One approach, long practiced by osteopathic physicians, has been largely dismissed by the rest of the medical profession. But some new evidence suggests osteopathic manipulation therapy, or OMT, which involves moving joints and muscles through soft tissue stretching and pressure, can make a real difference for many patients, especially those with lower back pain.

“Rather than going through a standard physical examination, we will actually put our hands on the patient to feel if there are any asymmetries or restrictions in the tissues,” said Dr. Jim Bailey, an assistant professor of rehabilitative medicine at the Rowan University School of Osteopathic Medicine in New Jersey. “If we find them we can use various techniques to correct that.”

Most of the scientific research into OMT over the years involved small patient samples, so positive results were easily dismissed. Insurers often refuse to reimburse for the procedure, treating it more like acupuncture or massage.

But that may change. A fairly large randomized, controlled trial of over 400 patients that appeared earlier this year in the Journal of the American Osteopathic Association found six OMT sessions were associated with “significant and clinically relevant measures for recovery from chronic lower back pain.”

This came on the heels of a 2014 meta-analysis—led by a German researcher who has worked with the respected Cochrane Collaboration—that found OMT helped reduce pain and improved function in both acute and chronic pain patients.

New interest in OMT comes in the wake of health officials asking doctors to write fewer opioid prescriptions. In March, the Centers for Disease Control and Prevention recommended doctors offer alternatives like exercise and cognitive behavioral therapy before resorting to opioids.

OMT is one such alternative. “What we're looking at to try to change pain situations is really restoring mobility and restoring normal movement,” said Sturdy McKee, owner of San Francisco Sport and Spine Physical Therapy. McKee is not a practitioner of osteopathic manipulation but says such therapies are a viable alternative to opioids.

Fears about the health risks involved with using opioids, which can include physical and psychological dependence and death, was what prompted Rose Mitropoulos, 54, of New Jersey, to visit Bailey earlier this year when she began suffering pain in her knees. She said she sought out a non-opioid alternative after witnessing the effects such medication had on her husband, who suffered from chronic lower back pain.

“They give him something and he took it for like five days and he just wasn't himself,” Mitropoulos said. “We don't like to resort to taking a pill for this or that.”

But drugs remain the first option for many physicians. “The messages we tend to receive when we get hurt are of a quick fix,” said Dr. Tim Flynn, an orthopedic physical therapist with provider Colorado in Motion. “Innovation sometimes means going back to the basics of what we've known and getting the right care for the right person at the right time.”

Bailey of the Rowan University School of Osteopathic Medicine said OMT fits that description to a T. “I think it increases body awareness for patients and it actually helps educate them on what certain symptoms in their body feel like.”

When used in conjunction with other types of therapies such as anti-inflammatory medications, it can be a viable alternative to opioids for treating chronic pain, he said.