A Proposed Mechanism: Osteopathic Manipulative Therapy's Potential Impact on Immune Cell Activity in Chronic Low Back Pain
By
Lily Tehrani
Jackson Gamer
Sarah Ballarin
Sebastian Arango
Nathan Widboom
Patrick Barry
Mark Sandhouse
Jill Wallace-Ross
Yasmin Qureshi
Lubov Nathanson
April 21, 2026
Clinical Scorecard: Osteopathic Manipulative Therapy's Potential Impact on Immune Cell Activity in Chronic Low Back Pain
At a Glance
Category Detail
Condition Chronic Low Back Pain (CLBP) Key Mechanisms OMT applies mechanical forces influencing immune cell gene expression and distribution, modulating inflammatory signaling and neuroimmune sensitization. Target Population Patients with chronic low back pain experiencing immune-mediated neuroinflammatory mechanisms. Care Setting Non-invasive, outpatient clinical settings utilizing osteopathic manipulative therapy.
Key Highlights
CLBP involves immune-mediated neuroinflammatory mechanisms with peripheral and central sensitization. OMT may modulate immune cell activity via mechanical pressure on lymphatic structures, altering cytokine production and gene expression. Current evidence supports OMT efficacy in reducing pain and improving function, but direct transcriptomic validation is limited. Guideline-Based Recommendations
Diagnosis
Recognize CLBP as a condition involving both peripheral immune activation and central nervous system sensitization. Consider immune-mediated inflammation as a contributing factor in chronic pain assessment. Management
Incorporate osteopathic manipulative therapy as a non-invasive, non-pharmacological treatment option for CLBP. Limit reliance on long-acting NSAIDs and opioids due to associated risks and side effects. Target both peripheral inflammatory mediators and central neural plasticity for durable pain relief. Monitoring & Follow-up
Monitor patient pain levels and functional improvement following OMT. Evaluate potential changes in inflammatory markers and immune cell activity as research evolves. Risks
Be aware of risks associated with chronic NSAID and opioid use, including addiction, overdose, renal failure, and gastrointestinal complications. OMT is generally safe but requires skilled practitioners to minimize adverse effects. Patient & Prescribing Data
Adults with chronic low back pain seeking non-pharmacological interventions.
OMT shows efficacy in pain reduction and functional improvement, potentially through immune modulation; further mechanistic studies are needed.
Clinical Best Practices
Use OMT techniques targeting musculoskeletal, lymphatic, and neurovascular structures to modulate immune responses. Employ a multidisciplinary approach addressing both immune and neural components of chronic pain. Educate patients on the benefits and limitations of OMT as part of comprehensive CLBP management. References
