The
researchers compared patient satisfaction and pain management for those
visiting osteopaths and medical doctors.
By Sara Heath
August 21, 2019 - Fundamental
tenets in osteopathic medicine, including whole-person treatments and an
emphasis on physician empathy, could improve patient satisfaction with care,
support pain management, and boost clinical outcomes, according to researchers from the
University of North Texas Health Science Center (UNTHSC).
As the nation faces
an opioid epidemic, medical industry leaders are looking for strategies to
promote pain management and patient satisfaction while also cutting down on the
number of medications used to treat pain. Calls for patient-centered care
abound, leaving providers consulting strategies that put emphasize the whole
patient.
The study, which
compared patient perceptions of care for both doctors of osteopathy (DOs) and
medical doctors (MDs), revealed that patients visiting DOs may experience
better care outcomes for chronic pain, and especially for lower back pain.
Looking at data for
patients in the PRECISION Pain Research Registry in the Texas area, researchers
also found that osteopathic care led to more patient satisfaction and
perceptions of physician empathy.
“The greater levels
of physician empathy and the better interpersonal manner reported by patients
who were treated by osteopathic physicians may be important mediators of
clinical outcomes in people with chronic pain,” said John Licciardone, DO, MS,
MBA, of UNTHSC Texas College of Osteopathic Medicine. “That patients
of osteopathic physicians reported lower levels of pain catastrophizing and
were more resilient and better able to cope with their pain may explain
their lower levels of disability.”
Osteopathy is
different from allopathy, or traditional medicine, the researchers said. The
practice is rooted in the philosophy that “(1) the human being is a dynamic
unit of function; (2) the body possesses self-regulatory mechanisms that are
self-healing in nature; (3) structure and function are interrelated at all
levels; and (4) rational treatment is based on these principles,” the team
wrote in their study.
And because of those
fundamental differences, the researchers hypothesized that patient perceptions of care quality would
be different.
“Such interpersonal
factors as physician empathy and communication style may be important
determinants in seeking and retaining osteopathic medical care,” they said.
“Empathy and communication style also represent 2 aspects of the medical
encounter that may contribute to patient satisfaction.”
Overall, patients
receiving pain management treatment from DOs reported better care outcomes.
These patients were less likely to be taking an NSAID or opioid to manage their
pain. Twenty-one patients visiting an osteopath said they took an opioid to
manage pain, compared to 81 patients visiting an MD. Fifty-one patients seeing
an osteopath took an NSAID for pain, while 159 of those visiting an MD said the
same.
And despite using
fewer medications, patients visiting DOs reported better pain control. These patients
were less likely to report pain catastrophizing and had better pain
self-efficacy, or the ability to manage their own pain and the negative
emotions that come with it.
Patients seeing an
osteopath likewise reported better patient satisfaction scores and rated
their patient-provider communications better. Specifically, patients visiting a
DO were more likely to say their provider’s interpersonal skills and empathy
levels were high.
This study was
limited because of its design, the researchers said. Because only patients
visiting DOs gave reviews of their DOs, and vice versa for those visiting MDs,
it is impossible to truly compare the two, the team acknowledged. In other
words, the researchers have no way of knowing if an individual patient would
have rated an MD the same as a DO because that patient did not visit an MD.
There may be temporal
variables, such as pain flare-ups at the time of patient surveying, that also
could have impacted results.
“Although a causal
relationship between these physician characteristics and their patient's
reported low back pain treatments and clinical status measures cannot be
established because of the cross-sectional design used in this study, the findings
suggest several questions about osteopathic medical care that warrant further
investigation,” they wrote.
The team did note
that this data could point to a path forward in managing pain during the opioid crisis. Recommendations from the
CDC and the American College of Physicians state that providers should first
use nonpharmacologic methods to treat chronic pain.
“However, successful
implementation of such recommendations may depend on the relationship between
the physician and patient during medical encounters for low back pain,” the
researchers concluded. “The findings of our study suggest that an ‘osteopathic
practice style’ (corroborated by such empirical findings as more favorable
patient perceptions of interpersonal manner and empathy) may facilitate
implementing the recommended treatment guidelines for low back pain.”
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