Per-protocol analyses for primary outcomes corroborated the statistical significance and clinical relevance of the intention-to-treat results (Table 3), including time

to initial clinical response (Fig. 3). The remaining per-protocol results were generally comparable to the observed intention-to-treat results and, therefore, are not reported herein. The clinical response and relapse profiles of these patients with moderate to severe chronic LBP provide a unique perspective on the short-term outcomes of OMT. Patients who received OMT experienced about twice as much Panobinostat cost substantial LBP improvement over time as those who received sham OMT. A large majority of rapid responders who were identifiable after one scheduled OMT

session maintained a clinical response to OMT at the week 12 exit visit. Typically, in patients who were clinical responders to OMT at week 12, three scheduled treatment sessions within four weeks were sufficient to cross the 50% pain reduction threshold for substantial LBP improvement. Thus, it appears that relatively few treatment sessions may be needed to attain and predict short-term response to OMT. The large effect size for overall short-term efficacy of OMT was driven by stable responders who never dropped below the 50% pain reduction threshold for substantial LBP improvement throughout the study. With the caveats of limited sample size and statistical power, and originally unplanned analyses, our subgroup analyses yielded findings Digestive enzyme that may help guide future studies in this field. There were very large RRs for Cyclopamine mw stable clinical response and clinical response at the week 12 exit visit in the subgroup

of patients with co-morbid depression vs. those without depression, although patients with depression were more likely to relapse. Other subgroups that consistently exhibited large RRs for stable clinical response and clinical response at the week 12 exit visit, coupled with small RRs for relapse, included those in the 21–39 year age category; current cigarette smokers; and patients with LBP duration greater than one year, greater deficits in back-specific functioning, and poorer general health. Although OMT was associated with decreased need of prescription rescue mediation (RR, 0.66; 95% CI, 0.43–1.00) in the originally reported outcomes of the OSTEOPATHIC Trial (Licciardone et al., 2013b), our present findings suggest that patients who concurrently use non-prescription medication for LBP may experience an enhanced response to OMT and decreased likelihood of relapse. It is interesting to review potential mechanisms by which OMT may exert its treatment effects in light of our subgroup findings. Previous analyses of OSTEOPATHIC Trial data have found reductions in serum tumor necrosis factor (TNF)-α concentration (Licciardone et al., 2012) and remission of psoas syndrome (Licciardone et al.