OMT as an Adjunct to Pain Management in a Patient with Von Hippel-Lindau Syndrome

1Hirsh C, 2Sergi M
1Akron Children’s Hospital, Akron, Ohio, United states; 2Ohio University Heritage College of Osteopathic Medicine - Cleveland Campus, Lowellville, Ohio, United states

Introduction: Von Hippel-Lindau disease is an autosomal dominant disorder due to mutations in the VHL tumor suppressor gene, resulting in the uncontrolled growth of hemangioblastomas. These growths can be located in the brain and spinal cord leading to a variety of symptoms including, but not limited to, headaches, ataxia, vomiting, and weakness. Hemangioblastomas can be located in other areas of the body and have potential to cause life-threatening complications. The use of OMT as additional treatment for chronic pain management can be beneficial in improving quality of life (QOL).
Materials and Methods: Akron Children’s Haslinger Family Pediatric Palliative Care Center is one of the largest pediatric palliative care programs in the U.S. and serves as a local, national and international model for the provision of high-quality care across the continuum. A patient from the program, a 23-year-old young man with Von Hippel-Lindau disease, was treated with various OMT techniques on an almost-monthly basis as an adjunct to his chronic pain management regimen over approximately 3-1/2 years prior to his death. The patient was diagnosed with multiple back and spinal cord hemangiomas, renal cell carcinoma, chronic back pain, constipation, depression, and sleep disturbance. The case report analyzes somatic dysfunction patterns, osteopathic manipulative techniques used, opioid dosing trends, and overall management of the patient’s pain in order to show benefit of OMT and the osteopathic approach to treatment in the management of chronic pain.
Results: With the use of muscle energy to treat cervical, thoracic, lumbar, and pelvic dysfunction, myofascial technique and soft tissue stretching in the back and cervical areas, and the suboccipital release, the patient always corrected or improved upon recheck. This allowed the patient to experience improvement of his symptoms, which reflected in his QOL.
Conclusion: Utilizing OMT as an adjunct therapy in the setting of chronic pain in a patient with Von Hippel-Lindau disease proved beneficial when analyzing the short- and long-term effects. This case reflects on the opportunity to provide OMT to patients with chronic pain in order to potentially decrease opioid use and increase QOL.
Discussion: Chronic pain causes physical, emotional, and psychological challenges which decrease QOL. Pain can become a daily focus, diverting patients from family, friends, and activities which they previously enjoyed. Osteopathic medicine focuses on treating the patient as a whole, which is synchronous with the palliative care program’s concept of a patient-focused and comprehensive approach to care. Overall, patients with chronic and complex disorders can significantly benefit from the incorporation of OMT into their care plan.
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