Assistant Professor of Emergency Medicine, Assistant Residency Program Director, University of Missouri-Columbia, 1 Hospital Dr # M562, Columbia, MO 65201, United States of America.
Osteopathic Manipulative Medicine, Tanana Valley Clinic, 1001 Noble Street, Fairbanks, Alaska 99701, United States of America.
Am J Emerg Med. 2024 Oct;84:74-80. doi: 10.1016/j.ajem.2024.07.050. Epub 2024 Jul 29.
Osteopathic manipulative treatment (OMT), also known as osteopathic manipulative medicine (OMM), is a set of manual techniques, developed by Dr. Andrew Taylor Still, founder of osteopathic medicine, initially limited to osteopathic medicine, for the treatment of painful conditions. This toolset is now used by allopathic physicians, international osteopaths, physical therapists, chiropractors, and other healthcare workers for the treatment of musculoskeletal pain. OMT can be used in the emergency department (ED) for the treatment of musculoskeletal complaints as an adjunct to pharmacologic agents (e.g., NSAIDs), or an alternative to opioids.
This narrative review provides emergency clinicians with an understanding of OMT, including a broad overview of the basis, development, and common subtypes of OMT; data on OMT efficacy and on the use of conditions commonly encountered in the ED setting; and information on how to implement the use of OMT in emergency medicine and urgent care settings.
OMT can be used for a wide variety of acute and chronic pain conditions, particularly back pain, headaches, neck pain, and extremity pain (assuming that life-threatening conditions have been excluded). There are small studies and case series demonstrating both efficacy and subjective improvement with OMT, including in the ED. However, limitations to the current body of literature include: small numbers of patients, challenges with blinding and standardization, limited adverse event reporting, and most research has been outside of the ED setting. There is great opportunity for future studies and application of OMT in the ED. There are an increasing number of emergency clinicians incorporating OMT in their practice and despite the perception of OMT requiring extended periods of time to perform, current data suggests OMT does not prolong ED visits or cost to patients. OMT is a procedure with billing codes, and courses and training in OMT are available for both osteopathic and allopathic physicians.
OMT is being used and has great potential in the management of acute and chronic musculoskeletal pain in the ED in addition to, or instead of pharmacologic agents, in particular as an opioid-sparing option.
整骨治疗（OMT），也被称为整骨手法医学（OMM），是由整骨医学的创始人安德鲁·泰勒·斯蒂尔博士开发的一套手动技术，最初仅限于整骨医学，用于治疗疼痛病症。该技术套件现在被包括内科医生、国际整骨医师、物理治疗师、脊椎按摩师和其他医疗保健工作者在内的人员用于治疗肌肉骨骼疼痛。在急诊科（ED）中，OMT 可作为药物（例如 NSAIDs）的辅助手段，或替代阿片类药物，用于治疗肌肉骨骼投诉。
本叙述性综述为急诊临床医生提供了对 OMT 的理解，包括对 OMT 的基础、发展和常见亚型的广泛概述；关于 OMT 疗效和在急诊科常见疾病中的应用的数据；以及有关如何在急诊医学和紧急护理环境中实施 OMT 的信息。
OMT 可用于治疗各种急性和慢性疼痛病症，特别是背痛、头痛、颈痛和四肢疼痛（假设已排除危及生命的病症）。有一些小型研究和病例系列研究表明 OMT 具有疗效和主观改善，包括在急诊科。然而，目前文献的局限性包括：患者数量少、盲法和标准化的挑战、有限的不良事件报告，并且大多数研究都在急诊科之外进行。未来在急诊科应用 OMT 有很大的机会。越来越多的急诊临床医生将 OMT 纳入他们的实践中，尽管人们认为 OMT 需要花费较长的时间来实施，但目前的数据表明 OMT 不会延长急诊科就诊时间或增加患者的费用。OMT 是一种有计费代码的程序，并且有针对整骨和内科医生的 OMT 课程和培训。
OMT 除了药物治疗之外，或者作为一种替代阿片类药物的选择，在急诊科管理急性和慢性肌肉骨骼疼痛方面正在得到应用，并且具有很大的潜力，特别是作为一种减少阿片类药物使用的方法。
