Osteopathic manipulative treatment vs. standard therapy in the management of acute neck and low back pain in the emergency department.

CONTEXT: Acute neck and low back pain are common emergency department (ED) presentations, generally treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Osteopathic manipulative treatment (OMT) is a hands-on treatment modality utilized to treat a variety of musculoskeletal conditions.

OBJECTIVES

We sought to evaluate the relative efficacies and side effects of hands-on OMT vs. one dose of oral ibuprofen, in the treatment of adult patients presenting with acute neck or back pain.

METHODS

We conducted a prospective randomized controlled trial at a high-volume urban ED. Adult patients with acute neck or low back pain were randomized to 5 min of OMT or oral ibuprofen 400 mg. Primary endpoint was the reduction in pain. Secondary outcomes included patient satisfaction and the rate of adverse events.

RESULTS

Thirty-eight patients were enrolled; 35 were included in the final analysis. Twenty patients were randomized to OMT, 15 to ibuprofen. Median pain reduction on the Numeric Rating Scale 11 (NRS-11) scale was 2.0 points for OMT and 1.0 point for ibuprofen (p=0.11) at 30 min; 2.5 points for OMT and 2.0 points for ibuprofen (p=0.22) at 60 min. There was no significant difference between groups. Nor were there any significant differences on the 5-point Pain Relief Scale (PRS-5) scale (p=0.36), or in any of the secondary outcomes.

CONCLUSIONS

In this small, unblinded, single-center randomized trial, we found no significant difference in utilizing OMT compared to 400 mg of oral ibuprofen for patients with acute neck or low back pain, regarding pain control, patient satisfaction, or side effects.