OMT of Somatic Dysfunction and Chronic Low Back Pain in Patients With Type 2 Diabetes Mellitus
| Status: | Terminated |
|---|---|
| Conditions: | Back Pain, Back Pain, Diabetes, Diabetes |
| Therapuetic Areas: | Endocrinology, Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - 79 |
| Updated: | 4/21/2016 |
| Start Date: | May 2014 |
| End Date: | November 2015 |
Osteopathic Manipulative Treatment of Somatic Dysfunction and Chronic Low Back Pain in Patients With Type 2 Diabetes Mellitus
The study hypothesis is based on osteopathic medical philosophy that: 1) the body is a unit;
2) the body has inherent self-regulatory mechanisms; 3) structure and function are
interrelated; and 4) rational treatment is based on an understanding and integration of
these concepts. Patients with type 2 diabetes mellitus often report more aches and pains
than people without diabetes. Because osteopathic manual medicine addresses dysfunction in
the musculoskeletal system, patients with both chronic low back pain and type 2 diabetes
mellitus may benefit from this non-pharmacological treatment to reduce their pain, thereby
reducing their stress and perhaps providing better clinical control for diabetes as
demonstrated by key markers such as hemoglobin A1c and kidney function. This study is an
extension of research completed in the OSTEOPATHIC Trial. Results of that study were
published in the Annals of Family Medicine in March/April 2013.
2) the body has inherent self-regulatory mechanisms; 3) structure and function are
interrelated; and 4) rational treatment is based on an understanding and integration of
these concepts. Patients with type 2 diabetes mellitus often report more aches and pains
than people without diabetes. Because osteopathic manual medicine addresses dysfunction in
the musculoskeletal system, patients with both chronic low back pain and type 2 diabetes
mellitus may benefit from this non-pharmacological treatment to reduce their pain, thereby
reducing their stress and perhaps providing better clinical control for diabetes as
demonstrated by key markers such as hemoglobin A1c and kidney function. This study is an
extension of research completed in the OSTEOPATHIC Trial. Results of that study were
published in the Annals of Family Medicine in March/April 2013.
SPECIFIC AIM 1:
To conduct a randomized controlled trial (RCT) to determine the efficacy of osteopathic
manual treatment (OMT) vs sham OMT in subjects with type 2 diabetes mellitus (T2DM) and
comorbid chronic low back pain (LBP). This will involve a 12-week protocol to study changes
in response to OMT in such outcomes as LBP severity (primary outcome measure), somatic
dysfunction, renal function, glycemic control, and other biomarkers potentially related to
T2DM.
SPECIFIC AIM 2:
Within the RCT, to corroborate previous findings indicating that patients with T2DM have a
high prevalence of tissue texture abnormalities in the T11-L2 spinal segmental region and to
determine if such findings can be statistically associated with the presence of diabetic
nephropathy using such laboratory measures as serum creatinine, urinary microalbuminuria and
macroalbuminuria, and the glomerular filtration rate.
SPECIFIC AIM 3:
Within the RCT, to explore potential mechanisms of action of OMT by longitudinally measuring
concentrations of biomarkers such as insulin, glucagon, cortisol, hemoglobin A1c, tumor
necrosis factor-α,interleukin (IL)-1β, IL-6, IL-10, and IL-18 in subjects with T2DM and
comorbid chronic LBP over 12 weeks. Significant changes in biomarker concentrations may help
explain the effects of OMT and whether such effects are mediated by changes in somatic
dysfunction.
To conduct a randomized controlled trial (RCT) to determine the efficacy of osteopathic
manual treatment (OMT) vs sham OMT in subjects with type 2 diabetes mellitus (T2DM) and
comorbid chronic low back pain (LBP). This will involve a 12-week protocol to study changes
in response to OMT in such outcomes as LBP severity (primary outcome measure), somatic
dysfunction, renal function, glycemic control, and other biomarkers potentially related to
T2DM.
SPECIFIC AIM 2:
Within the RCT, to corroborate previous findings indicating that patients with T2DM have a
high prevalence of tissue texture abnormalities in the T11-L2 spinal segmental region and to
determine if such findings can be statistically associated with the presence of diabetic
nephropathy using such laboratory measures as serum creatinine, urinary microalbuminuria and
macroalbuminuria, and the glomerular filtration rate.
SPECIFIC AIM 3:
Within the RCT, to explore potential mechanisms of action of OMT by longitudinally measuring
concentrations of biomarkers such as insulin, glucagon, cortisol, hemoglobin A1c, tumor
necrosis factor-α,interleukin (IL)-1β, IL-6, IL-10, and IL-18 in subjects with T2DM and
comorbid chronic LBP over 12 weeks. Significant changes in biomarker concentrations may help
explain the effects of OMT and whether such effects are mediated by changes in somatic
dysfunction.
Inclusion Criteria:
1. Fasting plasma glucose ≥126 mg/dL; OR
2. Oral glucose tolerance test ≥200 mg/dL; OR
3. HbA1c ≥6.5%
AND
4. Low back pain on most days for past three months; AND
5. Usual low back pain severity of 4 or greater on an 11 point numerical scale during
the past week.
Exclusion Criteria:
1. age less than 18 years or age greater than 79 years; OR
2. having a previous or current diagnosis of type 1 diabetes mellitus; OR
3. having a history of any of the following pancreatic or related disorders: (a) acute
or chronic pancreatitis, (b) pancreatic tumor or cancer, (c) Zollinger-Ellison
syndrome, or (d) any other medical or surgical condition resulting in functional
hypo- or hyperglycemia; OR
4. having end-stage renal disease; OR
5. having a history of any surgery involving the pancreas; OR
6. having a history of low back surgery in the past year; OR
7. receiving workers' compensation benefits in the past three months; OR
8. having involvement in ongoing litigation relating to diabetes mellitus or back
problems; OR
9. having a history of a stroke or transient ischemic attack in the past year; OR
10. having used intravenous, intramuscular or oral corticosteroids within the past month;
OR
11. attending a manual treatment session (OMT or any manual therapies delivered by
chiropractors or physical therapists) in the past three months, or more than three
times in the past year; OR
12. practicing osteopathic medicine, chiropractic, or physical therapy, or attending a
corresponding professional school; OR
13. being pregnant; OR
14. currently participating in another medical research study
Subjects will also be excluded if any of the following conditions are found during the
clinical screening:
1. presence of "red flag" conditions relating to LBP (cancer at any anatomical site,
spinal osteomyelitis, spinal fracture, herniated disc, ankylosing spondylitis, or
cauda equina syndrome); OR
2. angina or congestive heart failure symptoms with minimal activity; OR
3. active bleeding or infection in the lower back, or any other condition that might
impede protocol implementation; OR
4. discovery of the presence of any telephone screening exclusion criterion (EXCEPT that
the usual LBP severity over the past week may have declined from ≥4/10 points to
≥3/10 points during the lag time between screenings).
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