Opi­oid cri­sis re­news in­ter­est in os­teo­pathic ma­nip­u­la­tion

Modern Healthcare - - BEST PRACTICES - By Steven Ross John­son

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 of 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 an­ti­in­flam­ma­tory med­i­ca­tions, it can be a vi­able al­ter­na­tive to opi­oids for treat­ing chronic pain, he said.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.