Does Osteopathic Manipulative Treatment Induce Autonomic Changes in Healthy Participants? A Thermal Imaging Study

Francesco Cerritelli, Daniela Cardone, Alessio Pirino, Arcangelo Merla, Fabio Scoppa, Francesco Cerritelli, Daniela Cardone, Alessio Pirino, Arcangelo Merla, Fabio Scoppa

Abstract

Osteopathic manipulative treatment (OMT) has been demonstrated to be an effective therapy in several clinical conditions and age groups. Despite the clinical effectiveness, lack of robust data in terms of neurobiological, specifically autonomic, mechanisms of action is observed. Preliminary studies showed a parasympathetic effect leading to a trophotropic effect of OMT. However, these data are limited to heart rate variability (HRV) analysis. In order to study further the role of OMT on the autonomic nervous system, a cross-over randomized controlled trial RCT has been designed to test the effect of osteopathic treatment compared to sham therapy on a range of autonomic parameters. Thermal images, HRV and skin conductance data were collected on a sample of healthy adults. The study design consisted of two sessions (OMT and SHAM), 1 treatment per week, lasting 35 min each, composed of 5 min of baseline, 25 min of treatment, and 5 min of post-touch. During the baseline and the post-treatment, participants received no touch. Thirty-seven participants (aged 27 ± 5 years old, male ratio 40%) completed the study. Multivariate analysis showed a significant parasympathetic effect of group as well as of epoch on thermographic data of the nose (estimate 0.38; 95% CI 0.12-0.63; p < 0.01), left (0.17; 0.06-0.27; <0.001) and right (0.16; 0.07-0.24; <0.001) perioral as well as on the forehead (0.07; 0.01-0.12; <0.01) regions but not for the chin (0.08; -0.02 to 0.18; 0.13). Consistent with a parasympathetic effect, analyses demonstrated a difference between OMT and sham groups on the nuHF (p < 0.001) and DFA-a1 (p < 0.01) as well as on skin conductance (<0.01). The present research supports the hypothesis that a single session of OMT as compared to sham induces autonomic consequences in healthy non-symptomatic adults. Clinicaltrial.gov identifier: NCT03888456, https://ichgcp.net/clinical-trials-registry/NCT03888456.

Keywords: autonomic nervous system; cholinergic system; gsr; hrv; sham; touch.

Copyright © 2020 Cerritelli, Cardone, Pirino, Merla and Scoppa.

Figures

FIGURE 1
FIGURE 1
Flow-chart of the study.
FIGURE 2
FIGURE 2
Facial thermal changes in a representative participant receiving either osteopathic manipulative treatment or sham. Panels (a,d) represents baseline period before the touch timulation. Panels (b,e) show touch period. Panels (c,f) demonstrate post-touch period. A general temperature increase can be observed over the whole face in the osteopathic group as compared to the sham. In particular, while the chin slightly changes their average temperature values, nose tip, perioral, maxillary, and forehead regions clearly present a temperature increase where red areas can be easily spotted. OMT, osteopathic manipulative treatment.
FIGURE 3
FIGURE 3
Bar chart of thermic baseline differences changes of different region of interest (ROI) during the Touch (T1–T0) and Post-Touch (T2–T0) period. Values are mean ± standard errors of the mean. (A) nose tip; (B) forehead; (C) left perioral; (D) right perioral; (E) chin. OMT, osteopathic manipulative treatment. Black lines indicate the significant effect of Group. *p < 0.01.
FIGURE 4
FIGURE 4
The time course in minutes of thermic data in response to osteopathic manipulative treatment and SHAM during the 20-min-long Touch & 5-min-long Post-Touch periods. (A) Nose tip; (B) forehead; (C) left perioral; (D) right perioral; (E) chin. Data are presented as change in temperature-per-minute from Baseline in each period. The shaded area represents ± 1 standard errors of the mean. OMT, osteopathic manipulative treatment.
FIGURE 5
FIGURE 5
Bar chart displaying the mean heart rate variability (HRV) parameters values recorded in the baseline, Touch and Post-Touch period among the osteopathic and sham group. HF, high frequency in normalized unit; DFA-1, detrended fluctuation scaling exponent. Data presented are means ± standard errors of the mean. Black lines indicate the significant effect of Group. *p < 0.01. OMT, osteopathic manipulative treatment.
FIGURE 6
FIGURE 6
Bar chart of galvanic skin response (GSR) showing baseline differences changes during the Touch (T1–T0) and Post-Touch (T2–T0) period. Values are mean ± standard errors of the mean. Black lines indicate the significant effect of Group. *p < 0.01. OMT, osteopathic manipulative treatment.

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