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Journal: HCA Healthcare Summerville Hospital Date: 2026, , type of study: review

Free full text   (https://scholarlycommons.hcahealthcare.com/cgi/viewcontent.cgi?article=1178&context=southatlantic2026)

Keywords:

musculoskeletal pain [42]
medication [13]
opiods [2]
OMT [3825]
osteopathic manipulative treatment [3846]
chronic pain [313]
postoperative pain [6]
spinal cord injuries [3]
review [720]

Abstract:

Background: Musculoskeletal (MSK) pain is a leading cause of disability worldwide and is frequently managed with pharmacologic therapies, including nonsteroidal anti-inflammatory drugs and opioids. Given the risks of long-term medication use and the ongoing opioid crisis, there is increasing emphasis on nonpharmacologic, multimodal pain strategies. Osteopathic manipulative treatment (OMT) is a hands-on therapeutic modality used by osteopathic physicians to address somatic dysfunction and support physiologic regulation. Although OMT has demonstrated analgesic benefit in various settings, its impact on medication and opioid utilization has not been comprehensively synthesized. Objective: This narrative review evaluates the effectiveness of OMT in acute and chronic pain conditions and examines its potential medication and opioid-sparing effects. Furthermore, it evaluates treatment duration and frequency. Methods: A narrative review methodology was used to synthesize current evidence on OMT for pain management and medication-sparing effects. Included studies were selected from peer-reviewed clinical trials examining OMT for acute or chronic musculoskeletal pain, spinal cord injury (SCI)–associated pain, or postoperative pain, with reported outcomes including pain intensity, functional measures, patient satisfaction, and medication use. Studies were organized by clinical condition to facilitate thematic synthesis. Although formal meta-analysis was not performed, an evidence summary table (Table 1) was created to consolidate study characteristics, interventions, outcomes, and medication-related findings. Mechanistic considerations were incorporated to contextualize indirect opioid-sparing effects. Discussion: This narrative review synthesizes clinical evidence on osteopathic manipulative treatment (OMT) across acute and chronic pain conditions. Across multiple randomized and controlled trials, OMT consistently improved pain intensity, functional outcomes, and patient-reported measures in low back pain, neck pain, spinal cord injury–associated pain, and postoperative recovery. In several studies, OMT produced outcomes comparable to standard pharmacologic therapies and was associated with reduced analgesic consumption — notably decreased postoperative opioid use following total knee arthroplasty. These findings suggest OMT contributes to medication-sparing pain management strategies. As a nonpharmacologic, patient-centered intervention, OMT aligns with contemporary efforts to address the opioid epidemic through multimodal care. Its favorable safety profile supports integration across primary care and rehabilitation settings as both an adjunct and alternative to pharmacologic therapy. Despite promising results, gaps remains. Many studies lack standardized opioid consumption endpoints, and heterogeneity in study design limits generalizability. Future RCTs should incorporate explicit analgesic endpoints, standardized protocols, and longer follow-up. Comparative studies against physical therapy, acupuncture, and TENS would further define OMT's role in multidisciplinary pain frameworks. Evidence-based guidelines for treatment frequency and duration are still needed. Conclusion: OMT is a safe, effective intervention for managing acute and chronic pain, with emerging evidence suggesting indirect medication- and opioid-sparing benefits. When integrated into multimodal care pathways, OMT may reduce pharmacologic reliance, improve patient outcomes, and enhance overall satisfaction. These findings support the inclusion of OMT as a complementary approach in pain and rehabilitation practice, warranting further study to quantify opioid-sparing potential.

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