Role of Osteopathic Manipulative Treatment in Perioperative Pain Management: A Systematic Review With Exploratory Meta-Analysis.

Postoperative pain remains a significant clinical challenge, and opioid-based analgesia alone is often insufficient, while also contributing to adverse outcomes and long-term opioid dependence. Osteopathic manipulative treatment (OMT) has been proposed as a nonpharmacologic adjunct within multimodal postoperative pain management frameworks, but the evidence has not been formally synthesized. We searched PubMed, EMBASE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials in January 2026, supplemented by a manual journal search of the Journal of the American Osteopathic Association, International Journal of Osteopathic Medicine, Journal of Osteopathic Medicine, and Journal of Manual & Manipulative Therapy. Eligible studies were randomized or matched controlled trials that evaluated OMT as an adjunctive intervention in postoperative patients and reported quantitative pain outcomes. Primary outcomes included pain intensity, analgesic consumption, functional recovery, and length of hospital stay. Secondary outcomes included respiratory function, patient satisfaction, and adverse events. Three studies met the inclusion criteria and were carried forward to the final analysis. Two randomized controlled trials measuring postoperative pain via the Visual Analog Scale (VAS) demonstrated reductions of approximately 1.7 to 2.2 points in OMT-treated patients compared to controls at their respective assessment endpoints, exceeding established thresholds for clinical significance. A third prospective matched controlled study found that OMT patients achieved earlier functional milestones compared to controls, though differences in supplemental analgesic consumption were not statistically significant. An exploratory pooled analysis of the two VAS trials, using a DerSimonian-Laird random-effects model, yielded a mean difference of -1.16 (95% CI: -2.16 to -0.15); while this estimate excludes zero, with only two contributing studies and substantial heterogeneity (I² = 86.3%), it remains statistically fragile and should not be interpreted as confirmatory. The narrative synthesis of individual trial results provides a more defensible basis for clinical inference at this stage: across independent controlled trials in cardiac and orthopedic surgical populations, OMT was consistently associated with reduced pain, lower analgesic requirements, and faster functional recovery. Formal meta-analytic conclusions are not warranted given the current evidence base. Larger multicenter trials with standardized protocols are needed to define OMT's role in perioperative care.