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Integrating pain phenotype stratification into osteopathic clinical reasoning: A pilot feasibility study

Journal: Journal of Bodywork and Movement Therapies Date: 2026/10, 48Pages: 1272–1279. doi: Subito , type of study: observational study

Full text    (https://www.bodyworkmovementtherapies.com/article/S1360-8592(26)00291-3/fulltext)

Keywords:

clinical reasoning [84]
musculoskeletal pain [46]
observational study [234]
OMT [3896]
osteopathic manipulative treatment [3917]
pain phenotype stratification [1]
pilot study [210]

Abstract:

Introduction The integration of pain mechanisms into clinical reasoning is encouraged by advances in pain neuroscience, but its feasibility within routine osteopathic practice remains understudied. Objective To assess the feasibility of integrating a pain phenotype stratification procedure into osteopathic clinical reasoning and to describe exploratory changes in clinical measures following a single osteopathic manipulative treatment (OMT) session. Methods A single-arm, observational pilot study was conducted among participants with musculoskeletal pain. Pain phenotype stratification was based on the DN4 questionnaire and pain duration, with a three-month duration threshold used as a pragmatic criterion to distinguish between nociceptive and nociplastic phenotypes in participants without evidence of a neuropathic phenotype. The primary outcome was the feasibility of integrating the stratification procedure into routine osteopathic consultations. Secondary outcomes explored changes in pain intensity and pain-related measures using the Numerical Rating Scale (NRS), Brief Pain Inventory (BPI), Short-Form McGill Pain Questionnaire (SF-MPQ), and Neuropathic Pain Symptom Inventory (NPSI). Results Thirty-five participants were identified as potentially eligible, of whom 20 were enrolled. Fifteen participants (75.0 %) completed the study protocol. The pain phenotype stratification procedure was completed for all participants who completed the protocol. No statistically significant differences were observed for exploratory outcomes. Conclusion This pilot feasibility study suggests that a standardised pain phenotype stratification procedure can be integrated into osteopathic clinical reasoning under routine clinical conditions. Exploratory changes following an OMT session do not permit conclusions regarding treatment efficacy. Controlled studies are warranted to determine the clinical value of incorporating pain phenotype stratification into osteopathic clinical reasoning.


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