Spinal Manipulation Improves Heart Surgery Outcomes

This week from Dr. Cerami and Utah Sports and Wellness

From: Annals of Thoracic Surgery, January 2017 (https://www.sciencedirect.com/science/article/abs/pii/S0003497516314382)

Quick Summary:

The aim of this study was to assess whether osteopathic manipulative treatment (OMT) contributes to post heart surgical sternal pain relief and improves postoperative outcomes. Eighty post-sternotomy patients were randomly allocated to receive a standard cardiorespiratory rehabilitation program alone (control group) or standard cardiorespiratory rehabilitation with spinal manipulation. Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Postoperative pain diminishes patients’ ability to cooperate, delays recovery and may lead to worse outcomes. Inadequately controlled postoperative pain negatively affects the immune system, wound healing, and pulmonary function. The manipulation in this study began the day after being discharged from the surgery department, and was administered for 5 days. The improvement in respiratory function was more marked in the [manipulation] group. The inspiratory volume was significantly greater in the [manipulation] group. Hospitalization was significantly shorter in the [manipulation] group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days). At the end of the rehabilitation program, the reduction in perceived pain was more marked in the [manipulation] group and the VAS score was significantly lower in [manipulation] patients than in controls. The combination of standard care with [manipulation] is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.

Abstract:

Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated to reduce pain in different clinical contexts, suggesting its potential utility after cardiac surgery. The aim of this open-label, controlled study is to assess whether OMT contributes to sternal pain relief and improves postoperative outcomes. Eighty post-sternotomy adult inpatients were randomly allocated one to one to receive a standardized cardiorespiratory rehabilitation program alone (control group) or combined with OMT. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation. At the start of rehabilitation, the control group and the OMT group had similar Visual Analogue Scale median scores (controls 4, interquartile range [IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean inspiratory volumes (controls 825 ± 381 mL; OMT 744 ± 291 mL; p = not significant). At the end of rehabilitation, the OMT group had a lower Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1 to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 ± 588 mL; OMT 1,781 ± 633 mL; p < 0.01). The analgesic drug intake was similar in the two groups. The hospitalization was shorter in the OMT group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days; p < 0.05). The combination of standard care with OMT is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.

These authors also note:

• “Uncontrolled postoperative pain is often responsible for neurologic complications, episodes of delirium, and other acute confusional states with a multifactorial pathogenesis.”
• “In addition to discomfort and suffering, pain may cause sleep deprivation, may delay return to normal functioning, and may have nociception-induced adverse effects on cardiovascular functioning and pulmonary morbidity.”
• Pain intensity was measured using a 10-cm visual analogue scale (VAS) ranging from “no pain at all” to “unbearable pain.”
• “Anti-inflammatory drugs may impair renal function, interact with platelet aggregation, and increase the risk of gastrointestinal damage and bleeding; analgesic drugs have detrimental neurologic effects and negatively affect visceral motility; and opioids may decrease survival during in-hospital resuscitation and increase duration of hospitalization.”
• “The combination of standard care with [manipulation] is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.”