Effectiveness of two osteopathic treatment approaches on pain, pressure pain threshold and disease severity in patients with fibromyalgia

Tobias Schmidt1,3, Anja Baumbach1, Julia Günther-Borstel1, Jessica Albers2, Anne Jäkel1, Cristian Ciranna-Raab1, Torsten Liem1,

1Osteopathie Schule Deutschland, Hamburg, Germany,
2Physiotherapie & Osteopathie, Hamburg, Germany,
3Sport- and Movement Medicine University Hamburg, Hamburg, Germany

 

Introduction:

Fibromyalgia syndrome (FMS) is primarily characterized by chronic widespread pain and decreased pain threshold, and characteristic symptoms including fatigue, sleep disorders, cognitive dysfunction, irritable bowel and bladder, headache, and a variety of somatic complaints (Jacobsen et al. 1993). Approximately 2% to 7% of the population are affected; with women 10 times more likely to develop FMS than men; and the occurrence of the condition increases with age (Bannwarth et al. 2009). FMS is commonly managed by several approaches: the use of analgesics, antidepressants, physical exercise, relaxation techniques, and educational programs (Goldenberg et al. 2004). The role of osteopathic manipulative treatment (OMT) in treating FMS remains largely unknown. Only one small pilot study on 24 female patients evaluated OMT, OMT and teaching, moist heat and no intervention, with ‘significant findings between the four treatment groups’ on measures of pain threshold, perceived pain, attitude toward treatment, activities of daily living, and perceived functional ability in favour of the use of OMT (Gambers et al. 2002).

Aims:

The aim of this study was to investigate the perceived effectiveness of both individualized and general osteopathic treatment compared to no intervention in patients with FMS.

Methods:

The study was performed as a single-center randomized controlled trial with two osteopathic interventions and an untreated control group. Patients in the two osteopathic groups received 10 osteopathic treatments (OMT or GOT = general osteopathic treatment) within a time period of 12 weeks. The control group did not receive any osteopathic treatment. Primary outcome was average pain intensity (API), assessed by the visual analog scale. Secondary outcome parameter was pressure pain threshold by means of a tender point score: 18 painful sensitive points were evaluated (Wolfe et al. 1990). These tender points were assessed by means of a pressure algometer (Wagner®FPX), exerting a pressure of up to 4kg. The algometer was positioned perpendicular to the tender point and the pressure continuously increased until the patient expressed a sensation of pain. Disease severity was assessed by the Fibromyalgia Impact Questionnaire (FIQ). One way ANOVA was performed to test differences between groups at baseline. Repeated-measures ANOVA with post-hoc correction (Bonferroni) was performed to determine differences within and between groups over time. The effect size was derived by calculating Cohens eta-squared (η2).

Results:

Fifty patients were randomized. API decreased significantly from 7.2 to 4.7 in the OMT group (95%CI = -3.5 to -1.5), from 6.3 to 4.3 in the GOT group (95%CI = -3.2 to -0.8), and increased slightly in the control group from 6.2 to 6.6 (95%CI = -0.3 to 1.1). Between-group differences were statistically significant. Within-group differences for tender point scores were statistically significant, but not the between group differences. FIQ scores decreased significantly in both osteopathic groups, between group differences were statistically significant.

Conclusion:

A series of osteopathic treatments might be beneficial for patients suffering from FMS. Future clinical trials should incorporate larger sample sizes, sham controls, longer intervention periods and adequate follow-up assessments in order to confirm the results of this present study.

 

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