http://www.cnn.com/HEALTH/9911/03/back.pain.care.wmd/
"Osteopathic manipulation may effectively treat back pain
Power over pain
November 3, 1999
Web posted at: 5:03 PM EST (2203 GMT)
By Mari N. Jensen
(WebMD) -- People with chronic low back pain who were treated with osteopathic manipulation used less medication and recovered as well as those who received standard medical care, a new study suggests.
Results published in this week's issue of The New England Journal of Medicine show that the two different treatment regimes were equally effective in reducing pain and improving range of motion for people who had low back pain for at least three weeks before they enrolled in the study. No matter which type of treatment they received, more than 90 percent of the patients said they were satisfied and would seek similar treatment again.
"Patients that for one reason or another would prefer manual therapy over medication can confidently choose that alternative," said lead author Gunnar Andersson, M.D., Ph.D., chairman of the orthopedic surgery department at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
One out of five Americans suffers from back pain, said Andersson. About nine out of 10 people older than age 30 will experience back problems sometime in their lives, according to the North American Spine Society, a non-profit organization of more than 2,000 medical professionals who treat spine problems.
For most of these people, the problem will resolve within six weeks, said Andersson, whose study was funded by the American Osteopathic Association. But pain that continues past the six-week mark is more difficult to treat.
Back pain sufferers, the authors said, have traditionally been prescribed pain and anti-inflammatory medications and physical therapy exercises and modalities, such as ultrasound or hot and cold pack treatments.
Osteopathic manipulation literally requires the "laying on of hands," during which the osteopathic physician performs a series of manual maneuvers and techniques to relieve tight joints and muscles, said study co-author Robert Kappler, D.O., an osteopathic physician at the Chicago College of Osteopathic Medicine in Downers Grove, Illinois.
To test whether these manipulations could provide faster recovery and relief, Andersson and his colleagues recruited about 155 patients and randomly assigned them to receive either standard medical therapy or osteopathic manual therapy. People whose back pain stemmed from specific diseases, such as cancer or scoliosis, were not included in the study.
During the 12-week study, people assigned to the standard-care group received a standard course of treatment including physical therapy and medication. People in the osteopathic group received osteopathic manual treatment, in addition to physical therapy and medications as needed.
Patients fared equally well under standard care and osteopathic treatment, according to study results. No matter which treatment they received, the patients had less pain and better range of motion by the end of the study.
Reduced pain may not be the only benefit to osteopathic manipulation, the authors wrote. The reductions in both the amount of medication used and the costs of physical therapy may be important benefits.
Speaking on behalf of the American Osteopathic Association, Boyd Buser, D.O., said the study demonstrates that "when osteopathic manipulative treatment is part of the total approach to patients with this type of back pain, we can achieve just as good outcomes with probably significantly less cost." Buser is an osteopathic physician at the University of New England College of Osteopathic Medicine in Biddeford, Maine and past president of the American Academy of Osteopathy.
But back pain researcher Paul Shekelle, M.D., said that osteopathy doesn't necessarily save money. While the study confirms that manipulation may be a viable way to treat back pain, he said, it would actually be more expensive.
"Let's diverge at the treatment point," explained Shekelle, an internist at the Greater Los Angeles VA Healthcare System. "I give you a month's worth of drugs and tell you to come back; versus treatment point B, where you would get six or eight visits, or whatever, to the osteopath. In the real world, you'd get two doctor visits.
"Now the question is whether you think those six osteopath visits are going to be less than the cost of a month's ibuprofen. No way. No way, man!""
