Osteopathy for Fibromyalgia – Another Theatrical Placebo Therapy

French researchers sought, in a randomized clinical trial, to evaluate the effectiveness of osteopathic manipulation for fibromyalgia (FM). Patients were randomized to osteopathic treatment or a placebo procedure (randomly assigned to groups). Treatment was delivered by experienced physical medicine physicians and consisted of six sessions per patient over 6 weeks. Treatment credibility and expectancy were assessed repeatedly.

What Is Osteopathy?

Osteopathic manipulative treatment, or OMT, is a set of hands-on techniques used by osteopathic doctors (osteopaths) to diagnose, treat and prevent illness or injury. An osteopath using osteopathic manipulation moves a patient's muscles and joints using techniques involving stretching, gentle pressure and resistance.

What Is Fibromyalgia?

Fibromyalgia (FM) is a condition that causes pain throughout the body (also called widespread pain), sleep problems, fatigue and often emotional and mental distress. People with fibromyalgia may be more sensitive to pain than people without fibromyalgia.

The Study of Osteopathy for Fibromyalgia

Osteopathic manipulation was performed as follows: For osteopathic treatment, the patient was first placed in a prone position. Each vertebral process from C7 to L5 was moved dorsoventrally with increasing pressure and in rotation by applying pressure to the lateral surface of the spinal process (bilaterally). The sacral (tailbone) bone was also manipulated 5-10 times. The piriformis muscles were gradually stretched. The hip joint was then gradually mobilized in extension combined with abduction and adduction to stretch the adductor, abductor and flexor muscles (10 times). The shoulders were progressively moved one at a time through repeated manipulation of the glenohumeral joint (10 times). The patient was then placed supine for the following maneuvers. Bimanual traction was performed on the neck, followed by repeated mobilization in lateral flexion and rotation (on both sides, five times, each 3-5 times). At the shoulders, cranial traction of both arms was performed first, followed by repeated caudal traction of one arm and then the other, opening the acromioclavicular and glenohumeral joints by blocking the clavicle (three times). At the hips, repeated traction was applied to the legs (three times), and the hip joint was mobilized through manipulation movements. Finally, the patient was placed in the lateral decubitus position to mobilize the lumbar and thoracolumbar spine. Thrust manipulation at each level was permitted according to the patient's complaint. Cranial traction of both arms was performed first, opening the acromioclavicular and glenohumeral joints by blocking the clavicle (three times), followed by repeated caudal traction of one arm and then the other. At the hips, repeated traction was applied to the legs (three times), and the hip joint was mobilized through manipulation. Finally, the patient was placed in the lateral decubitus position to mobilize the lumbar and thoracolumbar spine. Thrust manipulation at each level was permitted according to the patient's complaint.

The placebo procedure followed the same sequence, but maneuvers were stopped halfway to prevent joint mobility in the spine. Stretching techniques at the hips and shoulders were also stopped halfway. Joint techniques were simulated without substantial mobilization. Thrust manipulation was prohibited.

Patients completed standard questionnaires at baseline, during treatment and at 6, 12, 24 and 52 weeks after randomization. The primary outcome was pain intensity during the treatment period (assessed using a 100 mm visual analog scale).

As secondary outcomes, fatigue, function and health-related quality of life were included.

Results

• A total of 101 patients (94% women) were included.
• Osteopathic treatment did not significantly reduce pain compared with the placebo procedure (the mean difference between the two procedures was 2.2 mm; 95% confidence interval, −9.1 to 4.6 mm).
• No significant difference was observed for secondary outcomes (fatigue, function and health-related quality of life).
• No serious adverse events were observed, although pain increased again at week 12 in patients treated with osteopathy.
• A significant reduction in pain was observed in patients who expected the treatment to be beneficial.

The authors stated that osteopathy offered no benefit over placebo for pain, fatigue, function and quality of life in patients with FM, as their conclusion . These findings do not support using osteopathy to treat these patients. More attention should be paid to patients' expectations in managing FM.

The French team should be congratulated on this excellent research. This is a very well-conducted and reported study. It should serve as a blueprint for manual therapy researchers in future trials. The results are clear and not unexpected: Osteopathy is a theatrical placebo and nothing more.