Authors
Avrohom Levy, Haili Bach, Fernando Medina Carbonell, Aniruddh Setya
Published in
Frontiers in medicine. Volume 13. Pages 1839129. Epub Oct 09, 2026.
Abstract
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.
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.
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.
PMID:
42920523
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.
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