Any DO psychiatrists who make use of osteopathic manipulative therapy?

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I'm just curious if there are any. I am interested in becoming a psychiatrist, but part of me also wants to continue using OMT in some form (maybe not with psych patients, but perhaps as a part-time job in another clinic). I believe I'm actually pretty good at it, and though it's not something that I could see myself doing day in and day out, I feel like my skills would go to waste if I didn't at least use OMT on occasion. Also I wonder if there are any circumstances in which OMT could be applied in a psychiatry setting (such as for treating chronic pain, perhaps)?
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CTR said:
I'm just curious if there are any. I am interested in becoming a psychiatrist, but part of me also wants to continue using OMT in some form (maybe not with psych patients, but perhaps as a part-time job in another clinic). I believe I'm actually pretty good at it, and though it's not something that I could see myself doing day in and day out, I feel like my skills would go to waste if I didn't at least use OMT on occasion. Also I wonder if there are any circumstances in which OMT could be applied in a psychiatry setting (such as for treating chronic pain, perhaps)?
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I heard those patients unresponsive to psychotherapy and psychotropic meds greatly benefit from cranial. But honestly, it'd be hard to distinguish the delusional one in the room, the psychotic patient on the OMM table or the psychiatrist with his/her hand on patient's head sensing the skull bone movements...
 
I think the only application would be in pain medicine or FP/psych. I'm guessing you're not referring to cranial, but I know of a psychiatrist who did an OMM fellowship and supposedly integrates it. You could perhaps ask her. I'll dig up the link when I'm on a computer.
 
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Damn cranial, giving us all a bad name.
 
zac16125 said:
Damn cranial, giving us all a bad name.
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The interesting thing, however, is that I would believe cranial to actually be most useful in certain psychiatric settings, since the treatment and response is a completely subjective experience, much like many of the chief complaints.
 
I was thinking more along the lines of muscle energy, counterstrain, and HVLA. Cranial is one area I have no interest in. That being said, I believe cranial OMT might actually treat the myofascial tissue (rather than introduce any movement between cranial bones), and could potentially help with headaches in this manner. If some patients do derive benefit from cranial, perhaps it does have some value. It's just not for me.
 
CTR said:
I was thinking more along the lines of muscle energy, counterstrain, and HVLA. Cranial is one area I have no interest in. That being said, I believe cranial OMT might actually treat the myofascial tissue (rather than introduce any movement between cranial bones), and could potentially help with headaches in this manner. If some patients do derive benefit from cranial, perhaps it does have some value. It's just not for me.
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I agree. I think scalp massages work wonders for tension headaches. Also, after seeing a lot of scalps cut through on neurosurgery and a few temporal artery dissections, I have a renewed interest in the anatomical basis for rubbing my temples when I get a headache. I think that hands-on manipulation of the scalp, not the bones, can be helpful.

That said, I wouldn't do this as a psychiatrist. Or even a physician. It seems most of the "hands-on" manipulation that we are aware of, and that works, isn't actually done by physicians. Instead, we refer people to other specialists, like massage therapists, physical therapists, etc. I always ask chronic back pain patients if they've tried massage or physical therapy, and it's surprising how many have never thought of it. It's a great referral to make; but probably not worth the cost to a patient to have an MD do it at our rates.
 
I think repetetively laying hands on a patient you're also doing psychotherapy with is a recipe for a malpractice case alleging a boundary violation.
 
Doc Samson said:
I think repetetively laying hands on a patient you're also doing psychotherapy with is a recipe for a malpractice case alleging a boundary violation.
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Another reason why FP/psych (if it's a true combined practice) and perhaps pain management may be the only avenues of application.
 
I know of one attending psychiatrist who does manipulation on patients provided it's a one time thing where he's seeing the patient on a consult basis(and thus there will be no long term followup) and if it's musculoskeletal in nature.
 
Doc Samson said:
I think repetetively laying hands on a patient you're also doing psychotherapy with is a recipe for a malpractice case alleging a boundary violation.
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You must not practice in the bible belt 😉
 
Well, most OMM is done by physicians, I think, b/c its taught mainly to doctors. That being said there is a push to incorporate OMM into psychiatry more. I've discussed it with people in my furture program and the approach would be to use it on other people's patients who are referred to you for psych specific OMM. or you can go into inegrative medicine, pain management, etc. It requires some craetivity but I think is very doable and needed.
 
st2205 said:
The interesting thing, however, is that I would believe cranial to actually be most useful in certain psychiatric settings, since the treatment and response is a completely subjective experience, much like many of the chief complaints.
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An interesting point, and I'm all for anything that makes someone feel better. However, I refuse to act like I can feel a cranial rhythmic impulse, or that I can move fused skull bones with nothing more than light palpation.
 
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zac16125 said:
An interesting point, and I'm all for anything that makes someone feel better. However, I refuse to act like I can feel a cranial rhythmic impulse, or that I can move fused skull bones with nothing more than light palpation.
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Hey, I'm not advocating it by saying its application is more appropriate in psych, just that it's less appropriate other places.
 
Don't take this the wrong way. However, are any of you aware of any large RCT trials involving OMM for anything substantial?
 
Manicsleep said:
Don't take this the wrong way. However, are any of you aware of any large RCT trials involving OMM for anything substantial?
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What is RCT? You either believe it or you stay quiet!

OMM is not evidence-based; it is faith-based. Like topics on religion, you get yourself into trouble if you start asking questions for evidence; you just have to have faith in it, period. I've found that talking about RCT in the world of OMM is almost a taboo; it just angers those who believe in it, and some DOs feel that you are attacking their identity, even though, in reality that is not your intention. Like all the other treatment modalities that we use in medicine, physicians are always curious to know whether there is enough evidence to back up their treatment plan, that's all. Otherwise, no one takes your treatment modality serious if you can not back it up; it seems to me that OMM falls in this category at this time.

Disclaimer: This was just my personal opinion based on my experience (I am very familiar with OMM). This is absolutely not a debate between MDs and DOs or those premed's topics.
 
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It seems like with the hours of psyche, you could, conceivably, do OMM in a different 'practice' on the side. I've heard that it takes a while to get a solid OMM practice going, but I think if you had a steady income to supplement and did OMM on the side, you could probably build up a nice practice and do more and more of it.

You always hear of those OMM gurus who eventually switch an OMM practice to cash only and charge like $300 an hour cash with long, long waiting lists. Never know??
 
When I was a fellow, another fellow's wife practiced OMM/OMT/OPP (i have heard many different names) and helped me with my mid back.

She used myofascial (i think) techniques and although it wasn't a permanent fix, neither is ibuprofen. Anyways, I have searched for data on this but found nothing I can see that is of value.
 
Manicsleep said:
Don't take this the wrong way. However, are any of you aware of any large RCT trials involving OMM for anything substantial?
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There are plenty of trials comparing different OMM treatments to other forms of medical care. However, they tend to, of course, be more focused on things in which OMM is actually useful, namely MS-related pain. I will also add that there is a physiological basis for some of the techniques (ie. reducing gamma gain and other effects on muscle spindle fibers, etc). But its things like this ridiculous cranial garbage that gives the other potentially useful techniques a bad name.
 
It's also very difficult to randomize OMM, since the OMM practitioner always knows what technique they're trying to perform. That being said, there are many trials and meta analyses showing benefit of OMM in low back pain and headache, among other things. Check Dynamed for a good review of studies.
 
digitlnoize said:
It's also very difficult to randomize OMM...
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No, it's just hard to teach OMM practitioners research methodology, apparently. That's blinding, not randomization you're talking about, and while double-blinding has value, there are tons of medical questions that do not lend themselves to double-blinding. Have an OMM person do their thing, and have me go in there and give them a nice massage, and compare the results. Given how bad my wife gripes about my massages, if OMM can't beat me, it can't beat anything!
 
billypilgrim37 said:
No, it's just hard to teach OMM practitioners research methodology, apparently. That's blinding, not randomization you're talking about, and while double-blinding has value, there are tons of medical questions that do not lend themselves to double-blinding. Have an OMM person do their thing, and have me go in there and give them a nice massage, and compare the results. Given how bad my wife gripes about my massages, if OMM can't beat me, it can't beat anything!
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I'm sorry, apparently I can't type or think. I clearly meant blinding. In my defense, I'm neither a researcher nor an OMM practitioner. That being said, I do know the difference, but thanks for pointing out my mistake!

Still though, I think that even most lay people can tell the difference between most OMM and massage.
 
Psych based OMM.....2 brief examples. There are many techniques that can calm down sympathetic overdrive that might be contributing to anxiety. And, in general, mood can be negatively affected by chronic pain. So, there are indirect and direct applications. Also, I did have a bipolar pt. during my OMM rotation whose body felt and reacted entirely differently when she was off her meds and actively cycling.
 
Dr. teodor huzij, the aoa 2010 resident of the year, is a family practice, psychiatry, and omm boarded physician located in colorado springs. He was a military guy now in civilian medicine who uses omm in the psychiatry setting.
Whether omm can specifically treat the dysfunction present in a given diesease, it can still treat the person and promote health. thats the true use of OMM.
 
Manicsleep said:
Drs. Still no data.
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Have you tried the JAOA?

Granted, it's a journal specifically for osteopathic medicine, but of the 5-6 journals I have browsed through, 80% or better had plenty of substantiating 'data' to support the use of OMM/OMT in every health care practice.

Research for OMM/OMT is extremely limited by funding, but I was a participant in one just this past summer about the effects OMM had on pulmonary function tests (nothing to do with psych, but a personal experience).

The stuff works, there's no question; perhaps not as well as medication at times, but it works nonetheless, and I don't see anything wrong with implementing it into an FP/Psych practice or even Psych specific.
 
applied science said:
Dr. teodor huzij, the aoa 2010 resident of the year, is a family practice, psychiatry, and omm boarded physician located in colorado springs. He was a military guy now in civilian medicine who uses omm in the psychiatry setting.
Whether omm can specifically treat the dysfunction present in a given diesease, it can still treat the person and promote health. thats the true use of OMM.
Click to expand...

Drs. Do you appreciate the difference between anecdotes and scientific evidence (evidence-based medicine)? Does evidence-based medicine mean anything to you? Please please read the link below to familiarize yourself with these differences:

http://en.wikipedia.org/wiki/Anecdotal_evidence

We can discuss for hours many great incidents that you observed how OMM benefits patients, but in medicine, without SCIENTIFIC evidence, anecdotes are considered unreliable and unworthy. As physicians, we must be able to appreciate scientific methods and use scientific language when supporting a diagnosis or treatment modality; otherwise, you will not be taken seriously. A similar analogy would be if you were to insist that if I follow your religion, I will go to heaven; it may or may not be true, but in conclusion, it is certainly considered unreliable due to lack of evidence. Therefore, in medicine, we refrain from relying solely on anecdotal incidents or our beliefs due to many types of biases, placebo effects, and lack of statistical reliability. Case reports are basically anecdotes; although, such reports may open doors for more scientific studies in the future, they are never considered reliable source for patient care.
 
As a student from a DO-degree-granting institution, I see little use of manual medicine in Psychiatry. I echo the converse of this sentiment with regards to the field of physical medicine and rehabilitation, or the treatment of specific somatic disorders for which specific manual medicine modalities are proven effective.

Let's be practical. I echo many of the sentiments stated in this thread regarding doctor-patient boundaries, especially in Psychiatry, given the sensitive nature of our patient population. I will be much more inclined to perform EBM-proven psychotherapy techniques and medication in the long-term management of mental illness that responds to these specific treatments, than to risk experiencing the mental anguish and financial strain from having to go through a meritless lawsuit filed by a patient who perhaps truly believes that the doctor-patient relationship boundaries were compromised, despite ones best intentions. Put simply, whether from an EBM perspective (ie lack of "Psych-based OMM" -a novel concept, which in itself says something) or from a practical perspective, it's unwise.
 
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Mainly I was just interested in using OMT for musculoskeletal problems. I was wondering if it's possible to do psychiatry as my full-time job, and perhaps a little OMT on the side in a part-time job (for example, one or two half days a week in a general practice or OMT clinic).

I don't think there is much benefit to be gained from using OMT for treating psychiatric conditions. Could it possibly help with anxiety? I don't know, I guess we'll have to wait for the studies to come out on that one. But as far as using OMT in a psych practice I was thinking of possibly using it only for treating chronic pain conditions that are musculoskeletally-based and have been recalcitrant to other treatments. However, several have brought up good points about boundary issues and the role of the psychiatrist. Perhaps it would be better to simply refer out to the appropriate provider in this scenario.

However, I still entertain the idea of working in psych full time, and spending just a few hours a week doing OMT in a different clinic. Partly to keep my skills in use, and partly to mix things up a little. Any thoughts on this?
 
Manicsleep said:
Drs. Still no data.
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Look on Dynamed. Tons of data, most of it not very supportive, but some data strongl supportive of OMM use (HA, LBP). I'm not doing the work for you guys though, sorry...don't have the time right now.
 
the the scientific method post-
when your treating a specific, well defined dysfunction or disease state then the double blind studies, for which it seems you think determines the validity of everything in medicine, works well. I dont pretend omm should be used if there is no reproducible benefit. It's just that Ive spent the time to look up the research and it is undeniable it helps people.
Osteopathic philosophy seeks to find the health in patients. Health might seem silly to people who are trained that humans are just disease filled sacks and taught the "name that tune as fast as you can" method of diagnosis.
Do you think that psychiatric patient will be as productive, healthy, and well off as they can be if you treat their disease as something that only a pill can remedy? treating all parts of human;psychological, anatomical, nutritional and functional, is how you create healthy patients. The body is a unit and heals best when all parts are in order.
pills dont fix depression, although it can treat it in many cases.
studies have shown a few times that for mild to moderate depression, placebos, exercise and ssri's are of equal efficacy? put that in you double blind study pipe and smoke it.
 
Put that in your pipe and smoke it...yeah.
That about sums up it up.
 
Put that in your pipe and smoke it...yeah.
That about sums up it up.
 
applied science said:
the the scientific method post-
when your treating a specific, well defined dysfunction or disease state then the double blind studies, for which it seems you think determines the validity of everything in medicine, works well. I dont pretend omm should be used if there is no reproducible benefit. It's just that Ive spent the time to look up the research and it is undeniable it helps people.
Osteopathic philosophy seeks to find the health in patients. Health might seem silly to people who are trained that humans are just disease filled sacks and taught the "name that tune as fast as you can" method of diagnosis.
Do you think that psychiatric patient will be as productive, healthy, and well off as they can be if you treat their disease as something that only a pill can remedy? treating all parts of human;psychological, anatomical, nutritional and functional, is how you create healthy patients. The body is a unit and heals best when all parts are in order.
pills dont fix depression, although it can treat it in many cases.
studies have shown a few times that for mild to moderate depression, placebos, exercise and ssri's are of equal efficacy? put that in you double blind study pipe and smoke it.
Click to expand...

So... if I understand you correctly then I will summarize.

I looked up research that shows benefit but won't show you the research with any kind of link or citation.

Then about Osteopathic principles while using an immature stereotype to underhandedly take a swipe at Allopathic education.

Then move to more principles that everyone agrees with and I don't really see how it pertains to the topic at hand...

And finally mention a few more studies without providing any resources to them.

My only real response is that if you want it to be respected or believe it deserves to be respected then do what ManicSleep asked and

SHOW ME THE STUDIES! (in my best Jerry McGuire movie voice)
 
This is only a hypothesis so don't shoot me if I am way off.

I am guessing that D.O. schools end up producing 3 types of people.

A large cohort who believe that OMM is good for some things but not very good for other things. Most of these will never use OMM again.
A slightly smaller cohort who are disillusioned by OMM by the end of training and believe OMM is 90% rubbish and basically think of themselves as MDs with a different title.
A small group of students, residents and attendings who practice OMM, believe in OMM and probably have OMM done to them on a regular basis.

The 3rd group also probably form the core leadership of the Osteopathic Association. However, there is little effort to support or do research as the people are few so they just recycle data or do the same studies in different ways.
 
If not the case, with so many schools and so many osteopaths, cant you guys cough up a few trials of a few thousand people that is multicenter and an RCT?

I certainly do not want or mean to disparage osteopaths, I work with a lot of osteopaths and they are very competent. Just none of them do OMM. The one or 2 people that I know that do it, do it sort of as a boutique offering (not that there is anything wrong with that). Now I have seen OMM classes for MDs as well (by osteopathic schools) and I know that MDs have gone to them but my point is other than for a cutesy schtick, does OMM really have something to offer.

You can tell me to go find it myself, but if that is your answer, it means it isn't that easily available to DOs who should know this info like the back of their hands. Ergo, the data probably isn't out there and usually if the data isn't out there after this much time and opportunity its because the preliminary studies indicate its not going to be pretty.
 
Manicsleep said:
This is only a hypothesis so don't shoot me if I am way off.

I am guessing that D.O. schools end up producing 3 types of people.

A large cohort who believe that OMM is good for some things but not very good for other things. Most of these will never use OMM again.
A slightly smaller cohort who are disillusioned by OMM by the end of training and believe OMM is 90% rubbish and basically think of themselves as MDs with a different title.
A small group of students, residents and attendings who practice OMM, believe in OMM and probably have OMM done to them on a regular basis.
Click to expand...

I'd say this is fairly accurate. There are a few people that don't fit into the above groups or are more extreme voices of the three groups.

Manicsleep said:
If not the case, with so many schools and so many osteopaths, cant you guys cough up a few trials of a few thousand people that is multicenter and an RCT?
Click to expand...

That'd be nice.

I certainly do not want or mean to disparage osteopaths, I work with a lot of osteopaths and they are very competent. Just none of them do OMM. The one or 2 people that I know that do it, do it sort of as a boutique offering (not that there is anything wrong with that). Now I have seen OMM classes for MDs as well (by osteopathic schools) and I know that MDs have gone to them but my point is other than for a cutesy schtick, does OMM really have something to offer.
Click to expand...

There's a lot I'd like to add to this thread and will do so later, but haven't as of yet due to time constraints, unfortunately. One thing that would be appropriate is to define what we're talking about when we say OMM. OMM is an umbrella term that encompasses numerous different treatment modalities addressing varied symptomatology and/or pathology, utilizing many different theories, yet they all somehow converge and get thrown under the umbrella of OMM, sometimes even arbitrarily, or even 'some guy once did this, thought that, and now we do this."

In this sense, OMM also overlaps with numerous other fields like PT, chiropractic, some massage therapy, and many others. This is another important point, because it has to be understood what we're talking about when we say "OMM works" or "does OMM really have anything to offer?"

You can tell me to go find it myself, but if that is your answer, it means it isn't that easily available to DOs who should know this info like the back of their hands. Ergo, the data probably isn't out there and usually if the data isn't out there after this much time and opportunity its because the preliminary studies indicate its not going to be pretty.
Click to expand...

I'll post a little later with some various examples -- both good and bad. The bottom line is that for non-MSK problems the evidence for OMM is ludicrous.
 
Psychoderm said:
Drs. Do you appreciate the difference between anecdotes and scientific evidence (evidence-based medicine)? Does evidence-based medicine mean anything to you? Please please read the link below to familiarize yourself with these differences:

http://en.wikipedia.org/wiki/Anecdotal_evidence

We can discuss for hours many great incidents that you observed how OMM benefits patients, but in medicine, without SCIENTIFIC evidence, anecdotes are considered unreliable and unworthy. As physicians, we must be able to appreciate scientific methods and use scientific language when supporting a diagnosis or treatment modality; otherwise, you will not be taken seriously. A similar analogy would be if you were to insist that if I follow your religion, I will go to heaven; it may or may not be true, but in conclusion, it is certainly considered unreliable due to lack of evidence. Therefore, in medicine, we refrain from relying solely on anecdotal incidents or our beliefs due to many types of biases, placebo effects, and lack of statistical reliability. Case reports are basically anecdotes; although, such reports may open doors for more scientific studies in the future, they are never considered reliable source for patient care.
Click to expand...

Drs. This took approximately 15 secs and were literally the first 4 things that popped up. I hope these (and the 1000's of similar ones which are just a click away thanks to Al Gore inventing the internet) suffice. Having the ignorance not to look for something doesn't mean it doesn't exist.

http://www.jaoa.org/cgi/content/abstract/102/6/321

http://www.jaoa.org/cgi/content/abstract/100/12/776

http://www.jaoa.org/cgi/content/abstract/105/2/57

http://www.biomedcentral.com/content/pdf/1471-2474-6-43.pdf
 
zac16125 said:
Drs. This took approximately 15 secs and were literally the first 4 things that popped up. I hope these (and the 1000's of similar ones which are just a click away thanks to Al Gore inventing the internet) suffice. Having the ignorance not to look for something doesn't mean it doesn't exist.

http://www.jaoa.org/cgi/content/abstract/102/6/321

http://www.jaoa.org/cgi/content/abstract/100/12/776

http://www.jaoa.org/cgi/content/abstract/105/2/57

http://www.biomedcentral.com/content/pdf/1471-2474-6-43.pdf
Click to expand...

Those Ns are pretty unimpressive, and I'd like to see some sham OMM as a control.
 
There needs to be some physical boundaries in psychiatry. As much as one tries to get the patient to be equal in their own care, the power balance is far from equitable.
 
Doc Samson said:
Those Ns are pretty unimpressive, and I'd like to see some sham OMM as a control.
Click to expand...
Agree with sham as a control. Accupuncture looked much more promising for all things in early small studies when they compared it to a no-treatment control. Once they started doing sham control plugging needles into non-therapeutic sites, things leveled off for a lot of treatment types.

One of the studies mentioned "light touch" as a control. Not sure if this is an attempt at sham, as I don't speak OMM.
 



A comparison of osteopathic spinal manipulation with standard care for patients with low back pain nejm-1999

Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial

Does osteopathic manipulative treatment (OMT) improves outcomes in patients who develop postoperative ileus: A retrospective chart review
[FONT=helvetica,arial]Adjunctive osteopathic manipulative treatment in women with depression: a pilot study

.And the study showing antidepressants arent warranted in many depression cases, The Journal of the American Medical Association (JAMA) January 6, 2010; 303(1):47-53 .

5 minutes of google scholar searching found these articles. if you dont believe that people can promote healing using their hands and knowledge of anatomy, then dont. But please dont say there isnt evidence because if I can in 5 minutes find evidence suggesting its use in pneumonia, illeus, low back pain, and depression, you can bet theres more evidence and better studies out there showing its benefits.
Of course we need more and better studies, but without medical device company and pharmaceutical industry money its hard to do large placebo controlled studies. No excuse, but it is reality.

It is hard to find much evidence supporting omm in the psychiatry world, but that pilot study above shows promise. I wouldnt blindly promote it on psychiatric patients, but they can have other dysfunction and disease that can warrant its use.
 
Thanks for the NEJM article.

RE: the JAMA article and antidepressants not being effective. They actually work really well for severe depression. Pain, much like mild to moderate depression is nebulous and placebo can be effective. This is why I think it would be great to see an OMM study with a sham protocol.
 
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