Interoceptive bodily awareness in patients seeking pain relief with osteopathic manipulative treatment: an observational cohort pilot study

Danielle K. Emmet, DO; Glenn Davis, MS; Stacey Pierce-Talsma, DO, MS; Jay H. Shubrook, DO; and Wolf Mehling, MD
Notes and Affiliations
Notes and Affiliations

Received: April 23, 2022

Accepted: February 14, 2024

Published: April 24, 2024

  • Danielle K. Emmet, DO, 

    Department of Physical Medicine and Rehabilitation, New York Presbyterian
    , Weill Cornell Medicine and Columbia University
    , New York, USA

  • Glenn Davis, MS, 

    College of Osteopathic Medicine,
    Touro University California
    , Vallejo, CA, USA

  • Stacey Pierce-Talsma, DO, MS, 

    College of Osteopathic Medicine,
    University of New England
    , Biddeford, ME, USA

  • Jay H. Shubrook, DO, 

    College of Osteopathic Medicine,
    Touro University California
    , Vallejo, CA, USA

  • Wolf Mehling, MD, 

    Department of Family and Community Medicine, Osher Center for Integrative Medicine,
    University California San Francisco
    , San Francisco, CA, USA


Context: Interoceptive bodily awareness (IBA) is one’s attentional focus on and relationship with comfortable and uncomfortable (e.g., pain) internal body sensations. Integrating IBA into research on osteopathic manipulative treatment (OMT) is growing, both as an outcome and predictor of treatment outcomes; however, it has yet to be studied in a clinical setting.

Objectives: We aimed to conduct a pilot study to measure IBA, with the Multidimensional Assessment of Interoceptive Awareness (MAIA), in patients seeking OMT for pain, and to test if OMT exposure may be associated with higher IBA as measured by the MAIA. The primary outcome was the change in MAIA scores, and the secondary outcomes were reduction in pain intensity, reduction in pain interference, and increase in participants’ perception of change post-OMT.

Methods: A convenience sample was recruited from individuals presenting for OMT appointments at a College of Osteopathic Medicine OMT teaching clinic. Participants were recruited into our single-arm observational cohort study (n=36), and categorized into one of two groups, OMT-naïve (n=19) or OMT-experienced (n=17), based on prior exposure to OMT. We measured MAIA scores and clinical pain-related outcomes prior to, immediately after, and at 1 and 3 weeks after a usual-care OMT session in the clinic. Covariates including experience with mind–body activities, non-OMT body work, and physical and emotional trauma were also collected to explore potential relationships. We utilized t tests to compare MAIA scores and pain outcomes between groups and across time points. Stepwise regression models were utilized to explore potential relationships with covariates.

Results: The OMT-experienced group scored higher on the MAIA scales “Not-worrying” (p=0.002) and “Trusting” (p=0.028) at baseline. There were no significant changes in the MAIA scores before and after the single OMT session. Analysis of secondary outcomes revealed that all pain outcomes significantly decreased post-OMT (p<0.05), with the largest relative improvements in the acute pain and OMT-naïve subgroups, with diminishing effects over time.

Conclusions: Assessing IBA with MAIA in a clinical OMT setting is feasible. There were significant positive correlations between OMT exposure and two of the eight MAIA scales. Future studies are justified to further explore this relationship.

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