In 2013, Licciardone, et. al., conducted study about Chronic pain which often complicates the management of diabetes mellitus, posing a significant challenge for patients and healthcare providers alike. However, recent findings from a subgroup analysis of the OSTEOPAThic Health outcomes In Chronic low back pain (OSTEOPATHIC) Trial suggest that osteopathic manual treatment (OMT) could offer meaningful relief for those grappling with both diabetes and chronic low back pain (LBP).

This randomized, double-blind, sham-controlled trial, conducted at a university in Dallas-Fort Worth, examined the effects of OMT and ultrasound therapy (UST) on chronic LBP. Among the 455 adult participants enrolled, 34 (7%) had diabetes mellitus, a group that became the focus of this specific analysis.

Baseline somatic dysfunction was assessed using the Outpatient Osteopathic SOAP Note Form, while a 100-mm visual analog scale tracked LBP severity over the study’s 12-week period. Additionally, serum concentrations of tumor-necrosis factor (TNF)-α were measured at both the beginning and end of the study for six patients in the diabetes subgroup.

The study revealed significant insights:

• Prevalence of Somatic Dysfunction: Severe somatic dysfunction was notably more common in patients with diabetes (79%) compared to those without diabetes (58%), a difference that was statistically significant (P=.01).
• Reduction in Pain Severity: Diabetic patients who received OMT experienced a significantly greater reduction in LBP severity over the 12-week period compared to those who received sham OMT. The mean between-group difference in changes on the visual analog scale was -17 mm (95% CI, -32 mm to -1 mm; P=.04), a clinically relevant improvement (Cohen d=0.7).
• TNF-α Serum Concentrations: There was a notable reduction in TNF-α serum concentration in patients receiving OMT, with a mean between-group difference of -6.6 pg/mL (95% CI, -12.4 to -0.8 pg/mL; P=.03), also clinically significant (Cohen d=2.7).

Interestingly, no significant changes in LBP severity or TNF-α levels were associated with UST over the study period.

The results suggest that OMT could be a valuable intervention for reducing LBP severity in diabetic patients, potentially through mechanisms involving decreased levels of TNF-α, a marker of inflammation. Given these promising outcomes, the researchers advocate for a larger clinical trial to more definitively assess OMT’s efficacy and mechanisms in this population.

As chronic pain management continues to evolve, these findings offer hope for diabetic patients suffering from LBP, highlighting the potential of OMT as a complementary therapeutic approach

Reference: Licciardone, J. C., Kearns, C. M., Hodge, L. M., & Minotti, D. E. (2013). Osteopathic manual treatment in patients with diabetes mellitus and comorbid chronic low back pain: subgroup results from the OSTEOPATHIC Trial. Journal of Osteopathic Medicine, 113(6), 468-478.