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The American Society of Health-System Pharmacists (ASHP) hosted its 2024 Midyear Clinical Meeting in New Orleans, spotlighting diverse pain management strategies.
Among the highlighted sessions was “Challenges in Pain Management and the Importance of Communication,” chaired by Tanya J. Uritsky, PharmD, BCPP, alongside faculty member Lee A. Kral, PharmD. The session delved into innovative approaches for addressing pain and emphasized the significance of interdisciplinary communication in complex cases.
A recent systematic review offers new insights into the efficacy of manual therapy in pain management. The findings were published in the Journal of Bodywork and Movement Therapies.
The review, conducted by Frances Williams, PhD, MD, and colleagues, analyzed whether manual therapy combined with exercise therapy could provide superior outcomes in managing chronic low back pain (LBP) compared to exercise therapy alone.
Low back pain is a global health challenge, significantly contributing to disability and diminished QOL. Traditional exercise therapies, including strengthening, stretching, and stabilization exercises, are well-established as effective interventions for improving function and reducing pain. However, adding manual therapy presents an intriguing enhancement to these outcomes.
Exercise Plus Manual Therapy Improves LBP
Manual therapy for LBP includes spinal manipulation, massage, muscle energy technique (MET), and myofascial release to alleviate pain, improve mobility, and enhance psychological well-being through tactile engagement. The review included ten randomized controlled trials (RCTs) and found that eight studies reported improved pain and disability outcomes when manual therapy was combined with exercise therapy.
Patients who received manual therapy experienced three main benefits:
- Pain reduction and improved disability. Across most studies, the integration of manual therapy provided measurable short-term relief in pain intensity and functional disability, often exceeding the benefits of exercise therapy alone.
- Enhanced treatment adherence. Manual therapy’s tactile and interactive nature appeared to foster greater patient satisfaction and adherence.
- Targeted modalities for specific needs. Techniques such as myofascial release and muscle energy techniques demonstrated promising results for improving mobility and reducing pain.
One study highlighted that MFR combined with core stabilization exercises improved spinal mobility and core endurance in older adults. Massage therapy, when paired with home-based exercises, elicited notable improvements in pain scores, radiculopathy symptoms, and flexibility, with one trial reporting greater reductions of paresthesia and disability compared to exercise alone. MET also showed promising results, particularly in increasing lumbar range of motion and reducing activity restrictions, though long-term benefits were not consistently demonstrated across studies.
The quality assessment of the included studies supports their comparability and relevance. All studies utilized standardized tools to assess pain and disability outcomes, most incorporating blinding and placebo interventions. Additionally, five studies conducted power calculations to ensure sufficient sample sizes, although some faced recruitment challenges. The robust designs of these trials enhance the reliability of findings, particularly when examining diverse manual therapy modalities such as spinal manipulation, MFR, massage, and MET. These methodological strengths underscore the appropriateness of comparing interventions across the studies.
Implications for LBP Treatment & Future Research
This research is particularly relevant for patients with challenging pain cases, where traditional methods may not suffice. The session, led by Dr. Uritsky and Dr. Kral, emphasized the importance of nuanced communication between patients and healthcare providers. This is essential in identifying which combination of therapies may yield the best outcomes for individual patients.
While manual therapy provides promising short-term benefits, the review calls for more robust research into its long-term efficacy. Comprehensive studies are needed to understand the mechanisms underlying these benefits and identify the patients most likely to respond to these interventions.
As pain management evolves, integrating manual therapy alongside exercise offers a path to personalized care, enhancing both clinical outcomes and patient satisfaction. For clinicians, this underscores the importance of interdisciplinary collaboration and multifaceted approaches to pain management.
