Osteopathic manipulative treatment as an adjunct therapy in a pediatric patient with chronic pancreatitis and visceral hyperalgesia: a case report.

BACKGROUND

Chronic abdominal pain arising from visceral hyperalgesia is difficult to manage, and the use of osteopathic manipulative medicine in pancreatitis-associated visceral hyperalgesia is rarely described. This case adds to the literature by highlighting a potential integrative, mechanism-informed approach for pain modulation in a complex pediatric patient.

CASE: A 17-year-old male with chronic pancreatitis in the setting of a heterozygous SPINK1 N34S (c.101A > G; p.Asn34Ser) variant, presented with acute-on-chronic abdominal pain severe enough to require escalating opioid therapy; imaging demonstrated calcifications, edema, and peripancreatic fluid collections. A multimodal treatment plan was initiated that included gabapentin, nortriptyline, and targeted osteopathic manipulative treatment. A secretin-enhanced MRCP obtained during a prior admission one month earlier demonstrated pancreatic calcifications, edema, and peripancreatic fluid collections. During the current hospitalization, serum lipase decreased from 979 U/L on admission to 90 U/L by hospital day 3, when gabapentin, nortriptyline, and targeted osteopathic manipulative treatment were initiated as part of a multimodal treatment plan. The patient had two sessions of osteopathic treatment and they were each associated with reductions in pain without adverse effects. As-needed opioid medications were discontinued by discharge as part of a multimodal therapy plan. The patient remained pain-free at one-month follow-up with minimal opioid use, suggesting a potential role for osteopathic manipulative medicine as part of a multimodal strategy in the treatment of chronic pancreatitis related pain. At three-month follow-up, the patient reported pain rated 4/10 occurring several times per week and subsequently underwent total pancreatectomy with islet autotransplantation for definitive management.

CONCLUSION

This case describes an association between OMT and short-term pain improvement within a multimodal treatment strategy for chronic pancreatitis-related visceral pain. Although causality cannot be established from a single uncontrolled observation, the findings support further investigation of OMT as a potential adjunctive therapy in pediatric patients with chronic pancreatitis and secondary visceral hyperalgesia.