In 2013, Licciardone et al. conducted a study to determine the response to osteopathic manual treatment (OMT) for chronic low back pain (LBP) based on the baseline severity of pain. The study utilized a randomized, double-blind, sham-controlled, 2×2 factorial design and enrolled 455 patients with chronic LBP, out of which 269 (59%) reported low baseline pain severity (LBPS) of less than 50 mm/100 mm, while 186 (41%) reported high baseline pain severity (HBPS) of 50 mm/100 mm or more.

The study provided six OMT sessions over eight weeks and assessed the outcomes at week 12. The primary outcome was substantial LBP improvement, defined as a pain reduction of 50% or more. The Roland-Morris Disability Questionnaire (RMDQ) and eight other secondary outcomes were also evaluated. The response ratios (RRs) and 95% confidence intervals (CIs) were used with Cochrane Back Review Group criteria to determine the effects of OMT.

The results indicated a substantial improvement in patients with HBPS who received OMT with a large effect size (RR, 2.04; 95% CI, 1.36-3.05; P<0.001). This improvement was accompanied by clinically important improvement in back-specific functioning on the RMDQ (RR, 1.80; 95% CI, 1.08-3.01; P=0.02). The effect size was significantly greater than those observed in patients with LBPS. In other words, patients with higher baseline pain severity experienced more significant improvement in their LBP and back-specific functioning after receiving OMT.

The study concluded that OMT can be an attractive option for patients with chronic LBP of high severity before proceeding to more invasive and costly treatments. The study suggested that OMT can provide clinically significant benefits in all other secondary outcomes in patients with HBPS, although the statistical significance and clinical relevance of the results varied.

The findings of this study contribute to the existing literature on the effectiveness of OMT for chronic LBP. The study’s use of a randomized, double-blind, sham-controlled design adds to the strength of its findings. The study also highlights the importance of considering the baseline severity of pain when evaluating the effectiveness of treatments for chronic LBP.

However, it is important to note that the study has some limitations. The study was conducted in a single center, and the generalizability of the results to other settings is unclear. Additionally, the study only evaluated the short-term effects of OMT, and the long-term effects are unknown.

In summary, the study suggests that OMT can provide significant benefits for patients with chronic LBP of high severity. The findings support the use of OMT as a non-invasive and cost-effective treatment option for chronic LBP. However, further research is necessary to confirm the effectiveness of OMT and its long-term effects.

Reference: Licciardone, J. C., Kearns, C. M., & Minotti, D. E. (2013). Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Manual therapy, 18(6), 533-540.