Decreasing Headache Pain Secondary to a Subarachnoid Hemorrhage with the use of Osteopathic Manipulative Medicine

Background: Controlling a headache (HA) secondary to a subarachnoid hemorrhage (SAH) can be challenging for most physicians. At Maine Medical Center in Portland, Maine, the neurointensivist and staff noticed a trend in decreasing HA pain caused by a SAH in patients treated with osteopathic cranial manipulative medicine and osteopathic manipulative medicine (OMM), more so than those treated solely with the traditional opioid approach. It was requested that a chart review of these patients be evaluated for an objective analysis of this observation. Hypothesis: A decrease in HA caused by SAH will be observed in the group treated with OMM in comparison to those treated with opioids alone. Methods and Materials: A retrospective, IRB approved, and exempted study reviewed 21 subjects with a SAH that were treated with OMM. This population was analyzed for a decrease in pain score following osteopathic treatment as well as for adverse events 6-month post treatment. Results: Pain scores were consistently reduced when comparing pre-and-post OMM treatment. After the first treatment, pain scores decreased by an average of 4 points, after the second treatment scores decreased by an average of 3 points and after the third treatment pain scores decreased by an average of 2.5 points. The number of adverse events recorded were found to be less than the national averages. Conclusion: The use of OMM as an adjunct with traditional treatments for a SAH can lead to a decrease in HA pain caused by a SAH. Minimal adverse events were observed.

Traditional Osteopathy and the General Osteopathic Treatment: A Historical Concept and a Modern Application

Historically, Andrew Taylor Still, MD, DO, differentiated osteopathic medicine from allopathic medicine with its unique approach to treatment using manual therapy. Those treatments, known as osteopathic manipulative treatment (OMT), are currently used to treat somatic dysfunction. The Educational Council on Osteopathic Principles (ECOP) includes different treatment methods, such as muscle energy, high-velocity, low-amplitude, Still techniques, myofascial release, and counterstrain, amongst others, under the category of OMT. Conversely, osteopathic practitioners outside the USA, mostly from Europe, use some techniques that are not necessarily documented as OMT by the ECOP. This is the case of the General Osteopathic Treatment (GOT). The GOT found its origin with Dr. Still and was promoted, amongst his contemporaries, by Dr. John Martin Littlejohn, DO, who founded the British School of Osteopathy in London. The general treatment, based on a strong biomechanical background, was further spread in Europe by John Wernham, DO, a British osteopath and one of Littlejohn’s students. Wernham developed and taught the GOT in its original form based on the principles and philosophy of osteopathic medicine. The goals of this article are to give an historical perspective of the GOT, to describe the foundation and concepts behind it, and to provide a review of the scientific literature of this treatment approach. The GOT can be used to diagnose and directly treat somatic dysfunction using the TART principle in a clinical setting. Besides the recognized contra-indications of treating somatic dysfunction, there are no clear scientifically published findings of contraindications for the use of the GOT. Like other OMTs, the GOT needs more scientific evidence to better understand its clinical applications.

A Network Meta-Analysis of Randomized Controlled Trials Directed at Treating Lateral Epicondylalgia

Background: Lateral epicondylosis is the most prevalent cause of lateral elbow pain, occurring in 4 per 1000 patients. The aim of most treatments is to reduce inflammation even with histological evidence demonstrating that lateral epicondylosis is a non-inflammatory condition. Objective: To determine the relative merits of the different regimens used to diminish lateral epicondylosis pain using a mixed treatment comparison/network meta-analysis (NMA). Methods: A thorough literature search was performed. The eligibility criteria for this mixed treatment comparison were: randomized controlled clinical trials; human subjects; working age population (16 to 70 years); the outcome measure was an objective pain assessment; measured at a 1- to 3-month follow-up. The NMA were performed using the GeMTC user interface for automated NMA utilizing a Bayesian Hierarchical Model of random effects. The evaluation of confidence in the findings from NMA was performed using a semi-automated platform called CINeMA (Confidence in Network Meta-Analysis). Results: The model suggests that articulation technique is the most effective measure for decreasing lateral epicondylalgia followed by topical nitrates, acupuncture, kinesiology taping and low-level laser therapy, respectively. Muscle energy technique, local corticosteroid injection, prolotherapy and counterforce bracing displayed a trend toward being less effective than placebo. Conclusions: The results suggest that the most effective modalities for improving lateral epicondylalgia are those that decrease muscle tone and those that improve circulation, while measures meant to decrease inflammation appear to be of no or limited benefit.

Correction: Conductive Hearing Loss: A Case Report

Editor's Note: This reprint of the September 2021 article Conductive Hearing Loss: A Case Report; Figure 2 was erroneously ommited from the original article and is now included alongside Figure 1 for appropriate context. AAO sincerely apologizes for the omission of the second figure in the original publication of this article.

An Osteopathic Approach to Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition in a region of the body where the pain experienced by the patient is disproportionate to the stimuli preceding the pain. In this case, a 52-year-old post-menopausal woman presents with chronic distal limb pain due to a left ankle contusion from a work injury. Previous treatments that focused on specific symptoms failed. However, the patient was then evaluated and treated comprehensively by an osteopathic physician. Treatment was tailored to individual patient needs based on the five models of osteopathic care. Within a 1.5 years period of integrative osteopathic treatment that utilized osteopathic manipulative treatment (OMT) in addition to medications and supplements, the patient was able to start walking again with only mild discomfort. This individualized approach seemed to improve her quality of life, and overall satisfaction with her health, psyche, and well-being. The patient is now discharged from the practice, has resumed normal daily activities, and is working full-time as a cashier.

Effects of Compression of the 4th Ventricle (CV4) Treatment on Medical Student Anxiety

Introduction: This study explores the effects of one Compression of the 4th Ventricle (CV4) treatment performed by experienced osteopathic physicians on reactive anxiety in healthy medical students. Anxiety was assessed with heart rate, blood pressure, and the Hamilton Anxiety Scale (HAM-A). Methods: Western University of Health Sciences IRB #15/IRB/113 was obtained for this single blind study. Volunteer first and second year medical students naïve to Osteopathic Cranial Manipulative Medicine, both in curriculum and as a patient, were recruited for this two-day study. Students were de-identified and demographic information was collected. On the first day, all 64 students received a sham treatment. Eight practitioners agreed on CV4 and sham techniques (mastoid cranial hold). In the CV4 technique, the operator’s thenar eminences contact the lateral angles of the occiput, and the operator encouraged the extension phase and discouraged the flexion phase of the CRI. Compression continued until a still point was reached in each student as identified by the practitioner. Students were evaluated before and after treatment using heart rate, blood pressure, and the Hamilton Anxiety Rating Scale (HAM-A). Results: No significant difference was found in demographics of the two groups. A significant difference between sham and CV4 treatments was found for heart rate (p=0.036), but not for systolic or diastolic blood pressure (p=0.446 and p=0.799, respectively). Average heart rate reduction of CV4 group was 3.11 and of sham group was 1.12, with p=0.036 (Mann Whitney U = 1271). Heart rate increased in a few students after both CV4 and sham treatments. Average HAM-A score for students before and after CV4 treatment were 21.9 and 18.3, with an average net reduction of 3.58 compared to the sham’s 2.77, but results were not found to be statistically significant (p=0.09, U=1172). Conclusion: A statistically significant average reduction in heart rate, but not in blood pressure or HAM-A scores, was found after CV4 treatment compared to sham treatment. More studies with larger samples are needed to further investigate the effects of CV4.

Single Osteopathic Manipulative Treatment Session Eliminates Percutaneous Coronary Intervention-Induced Upper Thoracic Pain in Elderly Male

Restoration of blood flow is critical to a blocked coronary blood vessel. With respect to the heart, two main procedures, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) revascularize the area to prevent future blockages. Post-procedurally, bed rest iatrogenically produces non-life-threatening back pain.1,2 No exact guideline for the duration of post-procedural bed rest exists but recommendations range from 2 to 24 hours.1 However, research has shown that bed rest beyond 4 hours significantly increased the presence of post-procedural back pain.1,2 Osteopathic manipulative treatment (OMT) is the term ascribed to a number of categories of manual techniques used by osteopathic physicians to treat somatic dysfunctions, to complement conventional management in patient care. In this case report, we discuss a patient with post-procedural upper thoracic pain that resolves with OMT, demonstrating that OMT may play a useful post-PCI role in the care of patients who undergo stent procedures.