Musculoskeletal Medicine and PainORIGINAL ARTICLE
Abstract
Context: Osteopathic physicians take a whole-person approach to medical care that may be seen in their relationships with patients and may involve utilizing osteopathic manipulative treatment (OMT) as an alternative to opioid therapy in patients with chronic pain.
Objectives: This study aimed to compare the outcomes of patients with chronic low back pain (CLBP) treated by osteopathic and allopathic physicians in the United States utilizing a pragmatic design reflecting medical care in real-world settings, including an assessment of potential mediators of osteopathic medical care.
Methods: A retrospective cohort study was conducted utilizing patients with CLBP selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from September 2016 through September 2024. Patients were followed at quarterly encounters for up to 36 months after PRECISION enrollment to determine if they were receiving their CLBP medical care from either osteopathic or allopathic physicians. Outcomes pertaining to pain, function, pain impact, health-related quality of life (HRQOL), and the frequency of chronic widespread pain (CWP) and CLBP recovery were also measured at these encounters utilizing generalized estimating equations. Results were adjusted for sociodemographic and clinical characteristics in multivariable analyses. Regression-based analyses were utilized to determine if OMT, opioid prescribing, or physician empathy mediate the outcomes of osteopathic medical care.
Results: There were 1,491 patients in the study, including 278 (18.6 %) and 1,213 (81.4 %) treated by osteopathic and allopathic physicians, respectively. A total of 8,854 encounters were completed over 36 months, including 2,107 (23.8 %) and 6,747 (76.2 %) in the osteopathic and allopathic medical care groups, respectively. The adjusted means (95 % confidence intervals [CIs]) for patients treated by osteopathic vs. allopathic physicians were 6.3 (6.0–6.6) vs. 6.5 (6.3–6.7) for low back pain intensity (p=0.05); 14.8 (13.8–15.8) vs. 15.6 (14.8–16.4) for back-related disability (p=0.008); 31.9 (30.6–33.2) vs. 32.7 (31.7–33.7) for pain impact (p=0.07); and 57.8 (56.7–58.8) vs. 58.4 (57.6–59.3) for HRQOL deficits (p=0.04). The frequency of CWP occurrence (risk ratio [RR], 1.00; 95 % CI, 0.87–1.15; p=0.98) and CLBP recovery (RR, 0.65; 95 % CI, 0.38–1.11; p=0.12) did not differ between the osteopathic and allopathic medical care groups after adjusting for potential confounders. The significant results pertaining to pain, function, and HRQOL were consistently and most strongly mediated by physician empathy and, to a lesser extent, by OMT.
Conclusions: This study found that patients with CLBP treated by osteopathic physicians reported better outcomes for pain, function, and HRQOL than patients treated by allopathic physicians over 36 months of follow-up. These effects of osteopathic medical care were most consistently and strongly mediated by physician empathy and, to a lesser extent, by OMT. Osteopathic medical care was not associated with decreased CWP occurrence or increased CLBP recovery.