What is osteopathy: an effective treatment or placebo

What is osteopathy

Osteopathy is a field of medicine that is based on the perception of the body as a whole. It is aimed at helping the patient with manual methods. The literal translation from Greek is "bone disease": ὀστέον - "bone" + πάθος - "disease".

Osteopathy can be attributed to manual therapy - the impact on the patient occurs only with the hands. But from massage, chiropractic and chiropractic treatment, this method of treatment differs in that it works not with the effect (specific symptom), but with the cause. That is, the goal is to improve the anatomical and functional indicators of the body as a whole.

The following sections of osteopathic therapy are distinguished:

• Craniosacral - responsible for the restoration of micromobility of the brain and spinal cord and surrounding tissues.
• Fascial - regulates the activity of the musculoskeletal system by acting on the fascia (connective tissue membranes that cover muscles, organs, blood vessels and nerves).
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• Visceral - aimed at eliminating violations in the mobility and work of internal organs.

It is believed that osteopathic techniques are most effective at the initial stage of the disease, when irreversible changes in an organ or system have not yet developed.

Osteopathic services are not included in the listOn the program of state guarantees of free provision of medical care to citizens for 2020 and for the planning period of 2021 and 2022 services provided under the CHI program. Prices for such treatment in Moscow, St. Petersburg, Yekaterinburg and other large cities range from 1,500 to 20,000 rubles for an appointment lasting 60 minutes.

How osteopathy began and became official

The founder of osteopathy is American doctor Andrew Taylor Still. He tookHISTORY - Andrew Taylor Still, MD, DO participated in the Civil War as a medic, and studied medicine under the guidance of his father. When Still's wife and four children died of meningitis, he decided that traditional medicine was not without its shortcomings, and delved into the study of the structure of the human body. The doctor devoted 30 years to this and acquired successful manual therapy skills.

By the time he became famous, Still rejected the possible infectious nature of diseases and explained everything by anatomical and physiological disorders. He believed that osteopathic techniques could completely cure any disease.

In 1892 Still foundedA. T. Still university American School of Osteopathy. Subsequently, similar schools were opened in England and France.

The first educational institution teaching osteopathy appeared in RussiaSchool history in 1994 in St. Petersburg - Russian Higher School of Osteopathic Medicine.

In 2003, the Ministry of Health of the Russian Federation approved guidelines on osteopathy: this technique was first recognized as a method of treatment in our country.

At the end of 2012, osteopathy was included in the nomenclature of positionsOn approval of the Nomenclature of positions of medical workers and pharmaceutical workers medical workers. In September 2013, this area of ​​therapy was included in the list of specialties in the training programs for doctors in residency. In October 2015, an order was issuedOn the nomenclature of specialties of specialists with higher medical and pharmaceutical education on the inclusion of osteopathy in the nomenclature of specialties of higher medical education. So, since 2015, only a doctor can be called an osteopath. In January 2018, an order was publishedOn approval of the procedure for providing medical care to the population in the field of "osteopathy" on the approval of a unified procedure for the provision medical care population on the profile "osteopathy".

But the abundance of these official documents says absolutely nothing about the effectiveness of this type of therapy.

Is osteopathy effective?

On the website of the Journal of the American Osteopathic Association, one of the articles presented country map, in which the activities of osteopathic doctors are licensed. These are Russia, China, Canada, USA, Brazil, Argentina, Great Britain, Sweden, Finland, Italy, Austria, Germany, Poland and some African countries. It should be remembered that licensing does not mean proof of the effectiveness of any industry - it is necessary to control the activities of doctors at the state level.

WHO still refersWHO Traditional Medicine Strategy 2014–2023. osteopathy to non-traditional, or traditional medicine. The opinions of other experts also tend not to favor this kind of therapy. For example, Vasily Vlasov (Doctor of Medical Sciences, Professor, Member of the CommissionCOMMISSION FOR COMBATING Pseudoscience under the Presidium of the Russian Academy of Sciences on the fight against pseudoscience of the Russian Academy of Sciences) in his interviews and articles equatesThe RAS supported Elena Malysheva in the debate about osteopathy osteopathy to alternative medicine without any evidence base:

John Snyder, MD and Fellow of the American Academy of Pediatrics, in his articleOsteopathy in the NICU: False Claims and False Dichotomies blows to pieces one of the studies allegedly confirming the effectiveness of osteopathy in children. In drawing conclusions, he urges: "It is time to recognize that osteopathy does not exist and to focus our efforts on improving the evidence-based approach to medicine."

Of course, much more often in the media meet interviews with osteopathic doctors who convinceIs osteopathy safe? Myths and truth us in the effectiveness of appropriate techniques, or articles on the benefits of osteopathy (especially for women10 myths about osteopathy forums and websites). As a rule, all of them mention the legalization of this area of ​​therapy in the Russian Federation and bypass the question of the evidence base.

By the way, it simply does not exist: existing studies do not confirm the effectiveness of osteopathy.

Thus, data from the Cochrane Systematic Review saySpinal manipulative therapy for chronic low-back pain that osteopathic techniques have a short-term positive effect on chronic low back pain. However, in the conclusions, the authors note that it is impossible to reliably compare these results using placebo. And they point out that osteopathy does not demonstrate a significant clinical effect in comparison with other forms of intervention.

Another systematic review showsThe effects of osteopathic treatment on psychosocial factors in people with persistent pain: A systematic reviewthat osteopathic techniques sometimes help reduce anxiety and psychological discomfort in patients with chronic pain. However, in some cases there was no improvement in the mental state of patients, and in others, the result was comparable to the effect of a normal conversation with a doctor without other types of intervention. The authors acknowledge the great heterogeneity of the groups in the review (by age, gender and localization of pain syndrome) and the use of various osteopathic techniques (lack of standardization in experimental group). In addition, 10 out of 17 studies in this review were not "blind": "blind" studies are more objective, as patients are not privy to the details of the trial. All of these conditions are critical in order to determine the validity of the conclusions.

The authors of another review, who studied works on the effect of osteopathy on the course of chronic inflammatory diseases, sayChronic Inflammatory Disease and Osteopathy: A Systematic Review about the impossibility to evaluate its effectiveness. The fact is that the studies reviewed were also not "blind", the groups of participants were heterogeneous in gender, age and diagnosis, and there were no control groups. In addition, the works did not describe the method of exposure and did not mention side effects.

In addition, there is very little recent research on osteopathy at the moment. Most of the works that consider the effect of osteopathy on the body are a retrospective analysis of data from various clinical studies.

The UK National Health Service mentions on its websiteEvidence - Osteopathythat although many people report good results after treatment with osteopaths, it is not always clear how effective the treatment actually turned out to be, or whether it was a placebo effect.

The articleThe paradox of sham therapy and placebo effect in osteopathy "The paradox of sham therapy and placebo effect in osteopathy", based on a systematic review, draw conclusions about the disadvantages evidence base osteopathy and the necessary measures to correct the situation.

Foreign and domestic studies have not revealed significant negative health effects of osteopathy. But in almost all of them there is an indication that the test does not meet international standards.GOST R 52379-2005. Good clinical practice holding.

conclusions

At all stages of the development of medicine, there were generally accepted methods of treatment, which were then rejected for lack of evidence of their effectiveness. So, hernias and convulsions were treatedEsmarch's mug: the history of invention "Tobacco enema" hemorrhoids - hot ironSkeletons from the cabinet of Russian history. BloodlettingA brief history of phlebotomy has been a panacea for all diseases for a long time. In the 1930s, Dr. Aleksey Andreevich Zamkov tested the drug based on the urine of pregnant women. And about 10 years of urine therapyNON-CONVENTIONAL WAYS OF WELLNESS OF THE MODERN CITIZEN: URINOTHERAPY was the official method of treatment in the USSR.

There is no consensus on osteopathy. However, most of the relevant studies do not support its effectiveness. And the results of many trials, in which a positive effect of such therapy is noted, cannot be called reliable due to violations of the rules for their conduct.

Most likely, harm from osteopathy can only be if the patient refuses traditional diagnostic methods and treatment. The patient and the doctor may simply waste time. But the choice is always yours.