Integrating Somatic & Visceral Osteopathic Techniques to Manage Chronic Abdominal Pain in a Patient with Ehlers-Danlos Syndrome: A Case Study

Background Chronic abdominal pain (CAP), defined as constant or recurrent pain lasting more than three months, is a common yet diagnostically and therapeutically challenging condition, particularly in patients with overlapping gastrointestinal (GI), musculoskeletal, and connective tissue disorders. Given its multifactorial pathophysiology, CAP often necessitates a multimodal treatment strategy. Osteopathic manipulative treatment (OMT) offers a hands-on, non-pharmacologic approach to address somatic and viscerosomatic dysfunction, but remains underutilized in managing complex CAP. Case Presentation This clinical vignette evaluates the effectiveness of OMT, including both somatic and visceral techniques, in managing chronic idiopathic right lower quadrant (RLQ) pain in a patient with complex comorbidities and inconclusive prior workup. The objective is to assess OMT’s therapeutic value and provide clinical insight into a structured, reproducible OMT protocol that may inform future educational and research efforts. A 25-year-old white woman presented with a two-year history of constant, sharp RLQ pain rated 1- 7/10 in severity. Prior evaluation included a negative abdominal computed tomography (CT) scan in 2023 and an unremarkable transabdominal and ovarian ultrasound during the study period. Her medical history was notable for Ehlers-Danlos syndrome, Celiac disease, irritable bowel syndrome-mixed (IBS-M), reactive hypoglycemia, and post-treatment Lyme disease syndrome. Over nine weeks, she underwent weekly, 20-60 minute OMT sessions. Treatments progressed from somatic-focused techniques (weeks 1–4) to combined somatic-visceral techniques (weeks 5–8) and visceral-focused treatment (week 9). Techniques included muscle energy, counterstrain, and visceral techniques targeting structures such as GI sphincters, fascia of Toldt, and the ileocecal valve. Pre- and post-treatment assessments included positional pain ratings (standing, supine, etc.), somatic dysfunctions (innominate rotation, sacral torsions), and Chapman’s and counterstrain points. Initial somatic-focused sessions yielded short-term pain relief (18-48 hours). However, addition of visceral OMT extended symptom relief up to three days. Notable improvements were observed in counterstrain and Chapman’s point tenderness, particularly those corresponding to the pancreas and ileocecal valve. By the end of treatment, average pain scores had decreased by 68% (right lateral) and 58% (left lateral), with all positional scores exceeding the common 30% threshold for clinically meaningful improvement. Discussion This case illustrates a diagnostic and therapeutic gap frequently encountered in outpatient care to manage chronic abdominal pain despite unremarkable imaging. The structured application of OMT, particularly with visceral integration, revealed clinically relevant dysfunctions not apparent through conventional diagnostics and provided meaningful, though transient, symptom relief. These findings support further exploration of OMT’s role in managing chronic abdominal pain in outpatient settings.