{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:50:35Z","timestamp":1791521435498,"version":"4.3.4"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>A 17-year-old male with chronic pancreatitis in the setting of a heterozygous SPINK1 N34S (c.101A\u2009&amp;gt;\u2009G; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1839129","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:27:13Z","timestamp":1791520033000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Osteopathic manipulative treatment as an adjunct therapy in a pediatric patient with chronic pancreatitis and visceral hyperalgesia: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Avrohom","family":"Levy","sequence":"first","affiliation":[{"name":"Pediatric Gastroenterology Division, Department of Pediatrics, Saint Louis University School of Medicine SSM Health Cardinal Glennon Children\u2019s Hospital","place":["Saint Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haili","family":"Bach","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology Division, Department of Pediatrics, Saint Louis University School of Medicine SSM Health Cardinal Glennon Children\u2019s Hospital","place":["Saint Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Medina Carbonell","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology Division, Department of Pediatrics, Saint Louis University School of Medicine SSM Health Cardinal Glennon Children\u2019s Hospital","place":["Saint Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniruddh","family":"Setya","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology Division, Department of Pediatrics, Saint Louis University School of Medicine SSM Health Cardinal Glennon Children\u2019s Hospital","place":["Saint Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2518","DOI":"10.1136\/gutjnl-2021-325855","article-title":"Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis","volume":"71","author":"Olesen","year":"2022","journal-title":"Gut"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2605","DOI":"10.1016\/S0140-6736(24)02187-1","article-title":"Chronic pancreatitis","volume":"404","author":"Thierens","year":"2025","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1056\/NEJMcp1809396","article-title":"Chronic pancreatitis","volume":"386","author":"Vege","year":"2022","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1097\/MPG.0000000000003439","article-title":"The role of surgical management in chronic pancreatitis in children: a position paper from the north American society for pediatric gastroenterology, hepatology, and nutrition pancreas committee","volume":"74","author":"Nathan","year":"2022","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1053\/j.gastro.2025.04.040","article-title":"Total pancreatectomy with islet autotransplantation for chronic pancreatitis","volume":"169","author":"Trikudanathan","year":"2025","journal-title":"Gastroenterology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e70030","DOI":"10.1111\/papr.70030","article-title":"Pain in chronic pancreatitis","volume":"25","author":"van Zeggeren","year":"2025","journal-title":"Pain Pract"},{"key":"B7","doi-asserted-by":"publisher","first-page":"34","DOI":"10.53702\/2375-5717-32.2.34","article-title":"An osteopathic manipulative treatment (OMT) evaluation and treatment protocol to improve gastrointestinal function","volume":"32","author":"Heineman","year":"2022","journal-title":"AAO J"},{"key":"B8","volume-title":"Atlas of Osteopathic Techniques","author":"Nicholas","year":"2022"},{"key":"B9","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1186\/s12906-023-04230-2","article-title":"Defining the landscape of patient harm after osteopathic manipulative treatment: synthesis of an adverse event model","volume":"23","author":"Unger","year":"2023","journal-title":"BMC Complement Med Ther"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1016\/S0140-6736(19)30430-1","article-title":"Perioperative opioid analgesia\u2014when is enough too much? 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