Short-term benefits of osteopathic manipulative treatment for chronic low back pain: systematic review and meta-analysis

Context Chronic low back pain (CLBP) is common and often managed within multimodal, nonpharmacologic pathways. Clarifying sham-controlled effects of osteopathic manipulative treatment (OMT) can guide early clinical decisions. Objectives This study aims to estimate the short-term (≤6 weeks) effects of OMT for CLBP, emphasizing sham-controlled comparisons. Methods We preregistered a systematic review and meta-analysis (PROSPERO [Prospective Register of Systematic Reviews] CRD420251154852) and followed PRISMA 2020 (Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020). Randomized trials enrolling adults with CLBP compared OMT with sham/attenuated OMT, usual care, or wait-list. The co-primary outcomes were pain (0–10; mean difference [MD]) and function (Oswestry Disability Index [ODI] or Roland–Morris Disability Questionnaire [RMDQ]; standardized mean difference [SMD]). Analyses were prespecified at end-of-treatment (≤6 weeks); the single crossover trial contributed pre-crossover data only. Searches covered MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase (EMBASE [Excerpta Medica dataBASE]), CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index of Nursing and Allied Health), and ClinicalTrials.gov through October 2025. Random-effects models (DerSimonian–Laird with Hartung–Knapp) summarized effects with I 2 and prediction intervals (PIs); risk of bias (RoB 2) and certainty (GRADE [Grading of Recommendations, Assessment, Development, and Evaluation]) were assessed. Results Seven trials (n≈378) met the inclusion criteria. Across five trials, OMT reduced pain vs. comparators: MD −1.32 on 0–10 scales (95 % confidence interval [CI], −1.71 to −0.93; I 2 =6 %; 95 % PI, −2.05 to −0.59). In sham-controlled analyses of function limited to ODI/RMDQ (k=2), OMT improved disability: SMD 1.75 (95 % CI, 1.37 to 2.13; I 2 =0 %). Adverse events were infrequently reported; where monitored, no serious adverse events were attributed to OMT. Certainty by GRADE was moderate for short-term pain and for sham-controlled function. Conclusions At ≤6 weeks, OMT reduces pain and improves function vs. sham without observed serious harms, supporting its use as a low-risk adjunct within guideline-concordant, nonopioid CLBP care.