Osteopathic Manipulative Treatment for Chronic Low Back Pain

To the Editor We read with great interest the study by Nguyen et al evaluating standard osteopathic manipulative treatment (OMT). We congratulate the authors for the quality of their methods in this randomized clinical trial but would like to raise important questions regarding the conclusion that has been made.

The first point is the choice of a standard OMT, based on the standardization of manual techniques on 7 anatomical regions only. There is an old yet still ongoing debate regarding the theoretical models proposed to understand osteopathic care. The authors obviously chose the biomechanical model reflected in standardized techniques, but this choice does not do justice to the complexity of osteopathic care. Contextual effects operate alongside manual techniques. Moreover, it would have been helpful to take into account with more details patient characteristics. The life context should have been discussed in a model oriented on psychosocial aspects that we know are of particular importance in lower back pain. Whereas it is admitted that the uniqueness of each patient implies the use of personalized treatment for each of them, the standardization of OMT of this study may have actually decreased its effect, thus making it falsely appear not different from placebo. It also appears that the comparative technique (light touch) is not an inert procedure, and the authors should have mentioned this as a limitation.