13/03/2020
Osteopathy, inflammatory disorders, and immune function
Warning: This post is LONG, and contains heavy doses of RESEARCH. You may want coffee, or green tea, or a subsequent nice lie-down.
I was looking into a specific autoimmune, inflammatory condition â in this case Crohnâs disease â for a client recently, when I came across this article:
https://www.ncbi.nlm.nih.gov/pubmed/25357218
For Crohnâs patients, its findings are excellent news. Osteopathy seems to significantly decrease the severity of between-flare-up symptoms of Crohnâs patients in remission, and so significantly improve their quality of life. But the findings are of broader interest too: the study looked not only at osteopathyâs effects on the âIBS-likeâ symptoms of Crohnâs patients, it also compared them to the symptoms of classical, non-inflammatory, non-autoimmune, IBS sufferers â and the osteopathic intervention they used was MUCH MORE EFFECTIVE for the Crohnâs patients.
The authors suggest, and Iâm inclined to agree, that the likely explanation is because the IBS-like symptoms in the two groups have different causes. Only in one group, namely the Crohnâs patients, are their IBS symptoms a result of the underlying inflammation and autoimmune dysfunction in the intestinal tract â and it is for that reason, they suggest, that osteopathy might have proven to be so much more effective in their study.
Why might they think that? What could the mechanism be, and what might the broader implications be for autoimmune and inflammatory disorders in general?
The answer looks as if could well lie in the interaction between osteopathic treatment and the endocannabinoid system.
The endocannabinoid system is of considerable scientific and therapeutic interest right now. It is unlikely to have escaped your attention that cannabis-derived oil - CBD, or cannabinidiol, oil - is all the rage, from health food stores to juice bars to online purveyors of âTHE 100%!!!!! PURE REAL STUFF!!!!â to the justified lobbying of Home Office ministers to listen to the evidence, overcome any reactionary conservative (small âcâ) prejudices they may still hold from the 1950s, and permit the import of what are literally life-saving medicines for epilepsy patients.
Thereâs good science behind some of these claimed effects for CBD oil; likely, thereâs little more than good marketing behind some of the others. What seems certain, though, is that thereâs a potentially broad-ranging, but still as-yet-not-fully-understood, role for cannabinoids in influencing our health.
The good science done so far - and thereâs a lot of it! - seems to indicate a huge range of possible effects (Zou & Kumar 2018 - see their diagram, linked in the pictures) but seems especially to point to a general role in managing inflammation (McCoy 2016, Neish 2018) and in regulating immune responses (Pandey et al 2009; Tanasescu & Constantinescu 2010).
This is of interest to osteopaths and our patients for two reasons: the first is to do with our position on drugs and medicines in general; the second is to do with the growing evidence that osteopathy may have direct, measurable effects on your bodyâs built-in cannabinoid receptors and the functions they control.
Firstly, osteopathyâs position on drugs and medicines in general:
Itâs one of the key tenets of osteopathy, going all the way back to Andrew Taylor Still, that âthe body has its own medicine chestâ. Broadly reframed to reflect our modern understanding, this is the idea that your body manufactures and distributes its own formulations of a wide range of compounds which we now make synthetically - painkillers, anti-inflammatory compounds, histamines and antihistamines, diuretics, anticoagulants, the lot - and, furthermore, the reason those synthetic drugs work on us AT ALL is precisely because we already make their home-made (or, if you prefer âendogenousâ) equivalents naturally in our own bodies â and THAT is the reason that we have receptors for those compounds on our cells. So, in short, everything a drug or medicine does to us is just a dialling up or down of a function that our bodies should already be able do, and for which we should already have our own endogenously-produced analogue which has the same exact set of effects.
What follows from there is the idea that, if and when CBD and other cannabinoid compounds have an effect, itâs because the tissues they affect have receptors for those compounds â or, more properly, receptors for the endogenously-produced compounds (henceforth, âendocannabinoidsâ) which the CBD is mimicking. Furthermore, whatever an externally-administered drug or medicine like CBD oil can do for us is something that, given the proper stimulus and in the right conditions, we should be able to do for ourselves, if only weâre able to produce the right endogenous compounds in the right amount, and get them to the tissues where theyâre needed.
Secondly, the particular relationship between osteopathy and the endocannabinoid system:
Early work in this area was carried out by McPartland and his colleagues, who found first that osteopathic treatment can mimic some of the subjective effects of cannabinoid intake (McPartland et al, 2005) â and yes, this may explain why some of you may have found that osteopathy can make you feel light-headed, or euphoric, or sleepy, or hungry, or otherwise mysteriously âa bit stonedâ! :) Having found this connection, McPartland went on to hypothesise a role for osteopathic treatment acting directly on the endogenous cannabinoid system (McPartland, 2008).
At around the same time, a pilot study looking for changes in blood chemistry after osteopathic manipulation found that several key markers of pain response altered with treatment (Degenhardt et al, 2007) - and one of those biomarkers whose concentrations changed the most, AEA (arachidonoylethanolamide) is â wait for it â a key compound in regulating the activity of the endogenous cannabinoid system (Zou & Kumar, 2018).
McPartlandâs and Degenhardtâs findings, together with the findings of several other studies in both humans and animals, led a recent review to conclude that âcollectively, the clinical and basic science research results ... suggest that manipulative therapy raises endocannabinoid levelsâ (Onifer et al, 2019).
This is fascinating. Not only does it offer a possible explanation for the findings in Crohnâs patients in the original article linked above, it also has potentially far-reaching implications for sufferers of other inflammatory and autoimmune conditions where the endogenous cannabinoid systemâs function or dysfunction is emerging as important: these include such chronic and debilitating conditions as Crohnâs and IBD, of course, but also multiple sclerosis, Parkinsonâs, Huntingtonâs, some forms of dementia, arthritises â the list is extensive, and includes a lot of conditions for which existing treatment regimes such as opioids or steroid injections or antidepressants are less than satisfactory.
To be clear, there is a lot still to be proven: weâre not yet at the point where we fully understand the endogenous cannabinoid system and itâs interaction with inflammation and immune function, and itâs apparent that itâs not as simple as âmore cannabinoids = GOODâ (although the CBD marketeers might want to have you believe that!); nor are we anywhere near being able to legitimately claim that we know for sure if, never mind how, osteopathic treatment interacts with those conditions in all patients.
It would be wrong, therefore, for osteopaths to say that we know we can treat those issues, or that by themselves those issues are reason enough to attend an osteopath. We just might, though, be at the beginning of understanding why some patients, who have called in for help with a musculoskeletal problem, have seemingly unexplained improvements in the symptoms of apparently unrelated problems after treatment.
Itâs early days, but, for people who suffer with challenges relating to long-term inflammatory or autoimmune issues, thereâs reason to be optimistic that a drug-free way to lower levels of inflammation and calm the autoimmune response might yet be found; and, if you already had a reason to visit the osteopath in any case, then perhaps the chance of improving your immune function, or decreasing any problems relating to chronic inflammation, might just turn out to be a welcome additional benefit!
Thanks for reading, as always, and Iâd love to know your thoughts.
~Ian
Oh, and the obligatory references and links, for those of you who might have had your curiosity piqued or who would like to check that I didnât just make this all up:
Zou & Kumar, 2018: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877694/
Pandey et al, 2009: https://www.ncbi.nlm.nih.gov/pubmed/19428268
Tanasescu & Costantinescu, 2010: https://www.ncbi.nlm.nih.gov/pubmed/20153077
McCoy, 2016: https://www.ncbi.nlm.nih.gov/pubmed/27597805
Neish, 2018: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6118573/
McPartland et al, 2005: https://www.ncbi.nlm.nih.gov/pubmed/16118355
McPartland, 2008: https://jaoa.org/article.aspx?articleid=2093607
Degenhardt et al, 2007: https://jaoa.org/article.aspx?articleid=2093447
Onifer et al, 2019: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662436/ #!po=42.5926
Piche et al, 2014: https://www.ncbi.nlm.nih.gov/pubmed/25357218
