Chronic nonspecific pain, unlike acute pain, is defined as lasting three months or longer, where no specific pathoanatomical cause can be identified. Dr. Jacek Cholewicki, working with a multidisciplinary team of researchers and clinicians, investigated the effects of osteopathic manipulative treatment (OMT) in patients with chronic nonspecific neck pain—a study he was motivated to undertake due to the scarcity of research on the topic.
Cholewicki, a professor in spinal biomechanics in the MSU College of Osteopathic Medicine Department of Osteopathic Manipulative Medicine and a member of the Center for Neuromusculoskeletal Clinical Research, explains that most people will experience an acutely painful episode at least once in their lives.
“A smaller percentage of them will go on to develop chronic pain. Even though it’s a small percentage, it still constitutes a huge health care problem that affects millions of people.”
Cholewicki found that OMT was effective in reducing pain and disability in patients with chronic neck pain. Not only that, but somewhat surprisingly, OMT also improved patients’ sleep quality, fatigue and depression—conditions that “seem to go hand-in-hand with chronic pain in general,” he noted.
Both chronic, nonspecific neck and back pain are complicated problems with multiple contributing factors. “There is no silver bullet for treatment, but typically, a multimodal approach is recommended,” he says.
A common perception among chronic pain patients is that pain either has an organic cause—something that shows up on an MRI, for example—or it’s all in their head.
“I think it’s good to emphasize that all pain is ‘in your head.’ It has to do with feedback from sensory nerves and how the brain interprets it,” says Cholewicki. “Chronic pain leads to changes in the nervous system—patients can become overly sensitive to stimuli, or the brain is interpreting feedback incorrectly.” It doesn’t mean the pain isn’t real, but if changes in the neural system are perpetuating it, he says that treatment might require both physical and psychological components.
The findings will appear in a paper soon to be published in PM&R: The Journal of Injury, Function and Rehabilitation.
While research shows single interventions, like OMT or physical therapy, have clinically meaningful improvements in patient outcomes, it’s hard to predict who will respond to one treatment versus another. Instead, Cholewicki thinks a more effective first step in treatment would combine several interventions, with movement and exercise instead of bed rest being perhaps the single most important factor in preventing chronic pain.
Cholewicki says that osteopathic medicine's holistic approach to health care offers the perfect research lens from which to tackle the treatment of chronic pain. His findings that OMT had a positive effect on sleep, fatigue and depression have inspired him to delve further into how psychosocial aspects influence chronic pain, such as the benefits of human touch, the doctor-patient relationship, or the patient’s expectation that treatment will be effective.
“For my next research project, I’d love to look into how much biomechanics are addressed by OMT versus how much is psychosocial in patients who are getting good treatment results. This knowledge could perhaps help optimize OMT.”
Cholewicki noted that one of the College of Osteopathic Medicine’s research advantages is having specialists in a large variety of areas under one roof.
He advises doctors and medical students to empower the patient. “Self-efficacy seems to be the most important predictor of effective treatment,” he says. “Educate patients on treatment options—for example, that exercise won’t necessarily make it worse—so they can take charge of their own condition.”