Licciardone John C, Schultz Matthew J, Amen Brook
Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA.
Gibson D. Lewis Library, University of North Texas Health Science Center, Fort Worth, TX, USA.
J Pain Res. 2020 Jul 20;13:1839-1847. doi: 10.2147/JPR.S183170. eCollection 2020.
Chronic pain is a common condition that often interferes with work or other activities. Guidelines support the use of non-pharmacological treatments, such as spinal manipulation, in patients with chronic pain. Osteopathic physicians in the United States are uniquely positioned to manage chronic pain because their professional philosophy embraces the biopsychosocial model and they are trained in the use of osteopathic manipulative treatment (OMT) to complement conventional medical care. This narrative review provides current perspectives on the osteopathic approach to chronic pain management, including evidence for the efficacy of OMT based on systematic searches of the biomedical literature and the ClinicalTrials.gov database. Men, persons with low levels of education, and non-White and Hispanic patients are significantly less likely to have received OMT during their lifetime. Patients with low back and neck pain are most likely to be treated with OMT, and osteopathic manipulative medicine specialty physicians and family medicine physicians most often use OMT. However, many osteopathic physicians report using OMT infrequently. Although OMT is considered safe, based on millions of patient encounters over more than a century, there is limited evidence on its efficacy in treating chronic pain. The lone exception involves chronic low back pain, wherein there is evidence from systematic reviews, a large clinical trial, and observational studies. There is lesser evidence to support cost effectiveness and patient satisfaction associated with OMT for chronic pain. The only clinical practice guideline established by the American Osteopathic Association recommends that OMT should be used to treat chronic low back pain in patients with somatic dysfunction. Given the philosophy of osteopathic medicine, universal training of osteopathic physicians to use OMT, and national guidelines supporting non-pharmacological treatments for chronic pain, it is unclear why OMT use is reported to be remarkably low in physician surveys.
慢性疼痛是一种常见病症，常干扰工作或其他活动。指南支持对慢性疼痛患者使用非药物治疗，如脊柱推拿。美国的整骨疗法医生在管理慢性疼痛方面具有独特优势，因为他们的专业理念包含生物心理社会模型，并且接受过使用整骨手法治疗（OMT）以补充传统医疗护理的培训。本叙述性综述提供了关于整骨疗法治疗慢性疼痛的当前观点，包括基于对生物医学文献和ClinicalTrials.gov数据库的系统检索得出的OMT疗效证据。男性、受教育程度低的人以及非白人和西班牙裔患者一生中接受OMT的可能性显著更低。腰背痛和颈痛患者最有可能接受OMT治疗，整骨手法医学专科医生和家庭医学医生最常使用OMT。然而，许多整骨疗法医生报告很少使用OMT。尽管基于一个多世纪以来数百万次患者诊疗经历，OMT被认为是安全的，但关于其治疗慢性疼痛疗效的证据有限。唯一的例外是慢性腰背痛，对此有系统评价、大型临床试验和观察性研究的证据。支持OMT用于慢性疼痛的成本效益和患者满意度的证据较少。美国整骨疗法协会制定的唯一临床实践指南建议，OMT应用于治疗存在躯体功能障碍的慢性腰背痛患者。鉴于整骨疗法的理念、整骨疗法医生使用OMT的普遍培训以及支持慢性疼痛非药物治疗的国家指南，在医生调查中报告的OMT使用率极低的原因尚不清楚。
