Preventing progression from chronic to widespread pain and its impact on health-related quality of life: a historical cohort study of osteopathic medical care
Open accessAbstract
Context: It is generally acknowledged that osteopathic physicians take a holistic approach to patient care. This style may help prevent the progression of painful musculoskeletal conditions, particularly if combined with osteopathic manipulative treatment (OMT). Objectives: The study aimed to determine if osteopathic medical care lowers the risk of progression from localized chronic low back pain to widespread pain and lessens the impact of pain on health-related quality of life. Methods: A historical cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data acquired from April 2016 through March 2021. Registry participants aged 21–79 years with chronic low back pain at the baseline encounter were potentially eligible for inclusion if they had a treating physician, completed all four quarterly follow-up encounters, and did not report physician crossover at the final 12-month encounter. Eligible participants were classified according to the type of physician provider at baseline and thereby into osteopathic or allopathic medical care groups. Participants were also classified according to prior use of OMT at the final encounter. Widespread pain was measured at baseline and each quarterly encounter to determine the period prevalence rate of widespread pain and its severity over 12 months using the Minimum Dataset for Chronic Low Back Pain recommended by the National Institutes of Health. Participants who reported “not being bothered at all” by widespread pain during each encounter were classified as not having widespread pain, whereas those who were bothered “a little” or “a lot” at any quarterly encounter were classified as having widespread pain. The severity of widespread pain was measured by summing participant responses at each encounter. The Patient-Reported Outcomes Measurement Information System was used at each encounter to measure health-related quality-of-life (HRQOL) scores for physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. Results: A total of 462 participants were studied, including 101 (21.9%) in the osteopathic medical care group and 73 (15.8%) who used OMT. The mean age of participants at baseline was 52.7 ± 13.2 years (range, 22–79 years) and 336 (72.7%) were female. A lower period prevalence rate of widespread pain was observed in the osteopathic medical care group (OR, 0.47; 95% CI, 0.27–0.81; p=0.006) and in the OMT group (OR, 0.40; 95% CI, 0.21–0.75; p=0.004), although the latter finding did not persist after adjustment for potential confounders. The osteopathic medical care and OMT groups both reported lower widespread pain severity. The osteopathic medical care group also reported better age- and sex-adjusted outcomes for each of the seven HRQOL dimensions throughout the study. The OMT group reported better outcomes in five of the HRQOL dimensions. Conclusions: This study supports the view that osteopathic physicians practice a holistic approach to medical care that manifests itself through a lower risk of progression from chronic low back pain to widespread pain, lower widespread pain severity, and lesser deficits in HRQOL. Similar findings were generally associated with OMT use.
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The finding that physician empathy mediates the OMC total treatment effect corroborates prior findings involving longitudinal OMC outcomes and patient perceptions of osteopathic physician empathy.
“This not only corroborates prior findings involving longitudinal OMC outcomes [7,29,30] and patient perceptions of osteopathic physician empathy [15], but now directly links the latter with better outcomes among patients with CLBP.”
From The process and outcomes of chronic low back pain treatment provided by osteopathic and allopathic physicians: a retrospective cohort study (2023) · cites this paper as [29]
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- Authors
- Licciardone, J. C.
- Affiliations
- University of North Texas Health Science Center (US)
- Corresponding author
- Licciardone, John C.
- ORCID
- Licciardone, John C.
- Venue
- Journal of Osteopathic Medicine
- Publisher
- Walter de Gruyter GmbH
- Published
- 2021-09-23
- Volume
- 122
- Issue
- 1
- Pages
- 21-29
- ISSN
- 2702-3648 (ISSN-L)
- OpenAlex
- W3217749301
- Cited by
- 7
- References
- 19
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 2
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Osteopathic Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- osteopathic manipulative treatment, chronic low back pain, widespread pain, chronic widespread pain, health-related quality of life, pain progression, holistic care, pain intensity, physical function, anxiety and depression, social role participation, musculoskeletal pain prevention, patient-reported outcomes
- MeSH terms
- Adult, Aged, Female, Patient Care, Humans, Middle Aged, Quality of Life, Cohort Studies, Low Back Pain, Osteopathic Physicians, Young Adult
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