Home›Orthopedics & Sports Medicine› Osteopathic manipulative treatment shows no significant pain reduction in musculoskeletal pain meta-analysis
Osteopathic manipulative treatment shows no significant pain reduction in musculoskeletal pain meta-analysisOsteopathic Treatment Shows Potential for Reducing Joint and Spine Pain
medRxivPublished August 19, 2026Study authors: Hsiao, A. L.; Schimmel, G. C.; Kale, R. U.; Dimanlig, M. G.; Ortegosa da Cunha, M.; Myers, N. E.DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
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Key Takeaway
Interpret OMT's pain benefit cautiously; meta-analysis shows no statistically significant reduction in musculoskeletal pain.
This meta-analysis synthesized evidence from 3 randomized controlled trials involving 231 participants with structural musculoskeletal pain (spine and peripheral joints), including knee arthritis, shoulder pain, and cervical spondylosis. The intervention was osteopathic manipulative treatment (OMT) compared with other treatment modalities. The primary outcome was pain symptomatology measured on a Visual Analog Scale.
The pooled mean difference in pain reduction was -1.80 favoring OMT, but the 95% confidence interval [-7.31, 3.78] crossed zero, and the p-value was not reported but noted as not statistically significant. Therefore, the analysis did not demonstrate a statistically significant benefit of OMT over comparators.
The authors noted substantial heterogeneity (I² = 96% initially, reducing to 54.4% after removing one outlier), which undermines the reliability of the pooled estimate. The small sample size (n=117 for OMT, n=114 for non-OMT) and reduced statistical power further limit the strength of conclusions.
Adverse events, serious adverse events, discontinuations, and tolerability were not reported. The authors explicitly state that the efficacy of OMT in reducing structural musculoskeletal pain cannot be proven due to the small sample size and high heterogeneity.
Given the low certainty of evidence, clinicians should interpret these findings cautiously. OMT may be considered as an adjunctive option, but its superiority over other treatments for musculoskeletal pain remains unestablished. Further high-quality research with larger samples and more homogeneous designs is needed.
Researchers looked at how osteopathic manipulative treatment (OMT) affects people with structural musculoskeletal pain. This included individuals dealing with issues in the spine and peripheral joints, such as knee arthritis, shoulder pain, and cervical spondylosis. The study specifically measured changes in pain levels using a standard visual scale.
The analysis of three clinical trials involving 231 people showed that those receiving OMT reported lower average pain scores compared to those receiving other treatments. However, the researchers noted that these results were not statistically significant. This means the difference could be due to chance rather than the treatment itself.
It is important to note that this evidence comes from a small number of studies and has high variability between different trials. Because of these limitations, the effectiveness of OMT for these specific conditions cannot be proven at this time. Patients should speak with their healthcare provider to determine the best management plan for their specific condition.
What this means for you:
Osteopathic treatment may link to lower pain scores, but small study sizes make it hard to confirm its effectiveness.
Common questions
What conditions can osteopathic treatment help with?
The study looked at how osteopathic manipulative treatment (OMT) affected people with structural musculoskeletal pain. This included specific conditions such as knee arthritis, shoulder pain, and cervical spondylosis. The goal was to see if OMT could reduce pain symptoms for these types of joint and spine issues.
Is osteopathic treatment proven to work for joint pain?
The evidence is currently not strong enough to prove that osteopathic treatment works. While the study showed a lower average pain score for those receiving OMT, the results were not statistically significant. This is because the study involved a small number of trials and had high variability in the data.
How many people were included in this research?
The analysis included a total of 231 participants. Of those, 117 people received osteopathic manipulative treatment (OMT) while 114 people received other types of treatment modalities. This small sample size is one reason why the results are not yet definitive.
Structural musculoskeletal pain, defined as pain associated with musculoskeletal conditions of the spine and peripheral joints, afflicts persons widely, independent of demographic, and continues to contribute substantially to disability on a global scale. Osteopathic manipulative treatment (OMT) is a non-invasive therapy performed by osteopathic physicians, encompassing a wide variety of techniques meant to heal the dysfunctions manifesting structural musculoskeletal pain. However, the efficacy of OMT in relieving pain symptomatology remains subject to debate. This meta-analysis examines the effect OMT serves to manage structural musculoskeletal pain, measured on a Visual Analog Scale. Three randomized control studies (RCTs) were included, with a total of 231 participants, 117 of which received OMT as part of pain management treatment, the other 114 receiving other treatment modalities. Using the random effects model, the mean difference between OMT and non-OMT treated groups was -1.80 (-7.31; 3.78). Although this mean difference favors OMT with regard to greater reduction in pain, the finding is not statistically significant. Heterogeneity was found to be extraordinarily high (I2 = 96%) and statistically significant (p = <0.0001), albeit attributed to one of the papers, deemed an outlier. With its removal, heterogeneity was still moderate (I2 = 54.4%). Given these findings, the efficacy of OMT in reducing structural musculoskeletal pain cannot be proven. A significant limitation of this study was a low sample size, consisting of 3 RCTs, reducing statistical power. In addition, there was high heterogeneity between studies. More high-quality RCTs with larger sample sizes, standardized methods, and an examination of a broader set of structural musculoskeletal conditions are necessitated to better evaluate the contribution of OMT in pain reduction. Key Words: Pain Management, Osteopathic Manipulative Medicine, Osteopathic Manipulative Treatment, Structural Pain, Orthopaedics, Knee Arthritis, Shoulder Pain, Cervical Spondylosis
