Feasibility of Implementing Manual Medicine in the Multimodal Management of Veterans and Service Members with Chronic Low Back Pain

This feasibility study evaluating osteopathic manipulative treatment (OMT) as a multimodal, non-pharmacological approach for veterans and service members living with chronic low back pain. Recognizing that low back pain affects the vast majority of people over their lifetimes and is particularly prevalent among veterans, Researchers designed a two-year, Department of Defense-funded investigation to assess whether integrating OMT into usual care within Veterans Affairs settings is practical, acceptable, and potentially beneficial. The project responds to the complexity of chronic low back pain, an often multifactorial symptom with variable etiologies and responses to treatment, and aligns with the VA's Whole Health strategy to broaden nonpharmacologic pain management options.

The study will be implemented at Edward Hines, Jr. V.A. Hospital in Chicago, where veterans with chronic low back pain will be randomly assigned to receive either usual care or usual care augmented by regular OMT sessions. Outcomes will be measured at 12 and 24 weeks to capture short- and mid-term trajectories in clinical status. The investigators will evaluate core domains including pain severity, physical function, mental health, sleep quality, and medication usage, with particular attention to opioid and rescue analgesic reliance. By systematically tracking these measures, the team aims to determine not only clinical signal but also the logistical and operational aspects of delivering OMT within VA clinical workflows, such as provider availability, integration with existing providers, patient uptake, and potential barriers to access.

A core rationale for the study is practical: osteopathic physicians (D.O.s) are relatively scarce in many VA hospitals, and among practicing D.O.s only a small minority use OMT routinely. Th study emphasizes the need to make OMT accessible and familiar to a broader range of clinicians as a tool embedded within multimodal pain management rather than an isolated specialty service. If feasible and acceptable, OMT could offer a low-risk modality to restore musculoskeletal alignment and reduce somatic dysfunction that contributes to persistent pain and disability. The study's design prioritizes real-world applicability by situating interventions in standard care settings and measuring outcomes meaningful to patients and health systems alike.

Beyond clinical outcomes, the feasibility study will inform larger trials and implementation strategies. Findings will help delineate training needs, resource implications and the potential for OMT to reduce medication dependence and improve recovery trajectories among veterans. Nicodemus, who brings both clinical and research expertise and personal connection as a veteran, frames the research as an opportunity to expand safe, effective options and reduce adverse outcomes associated with chronic pain management. The study represents a pragmatic step toward integrating manual medicine into comprehensive care pathways for veterans with chronic low back pain.