Chronic musculoskeletal pain disorders account for 70% to 80% of chronic pain diagnoses in the United States. The most common conditions are low back pain, neck pain, headache disorders, and knee and hip osteoarthritis. Most evidence suggests that treatments for chronic pain are best used in combination, such as in multidisciplinary rehabilitation programs. Evaluation of individual treatments in isolation is limited by small sample sizes, high risk of bias, lack of standardization in clinician delivery and treatment dosage or intensity, and inconsistent categorization of treatment techniques. Moderate-certainty evidence supports the effectiveness of exercise-based therapies, whereas low- to moderate-certainty evidence supports the use of osteopathic manipulative treatment for pain management across multiple body regions. Additional available therapies include other types of manual therapy (eg, spinal manipulative therapy, chiropractic care), massage therapy, Rolfing, traction, transcutaneous electrical nerve stimulation, therapeutic ultrasound, laser therapy, dry needling, shockwave therapy, and kinesio taping.

Case 3. GH is a 50-year-old man with chronic shoulder pain due to rotator cuff tendinopathy. He has tried oral medications and home exercises with minimal relief. He heard about osteopathic manipulative therapy from a friend and asks you whether it would help his shoulder pain and limited mobility.

Chronic musculoskeletal pain disorders account for 70% to 80% of chronic pain diagnoses in the United States.¹ The most common conditions are low back pain, neck pain, headache disorders, and knee and hip osteoarthritis.²