The AAO Journal, 2024/06, 34(2):11-12. doi: 10.53702/i2375-5717-34.2.7, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Keywords:

caesarean section [17]
case report [736]
childbirth [59]
female [655]
OMT [3925]
osteopathic manipulative treatment [3946]
post-operative care [84]
scars [14]
women [608]

Abstract:

Introduction/Background: Cesarean section and epidural anesthesia are both common procedures during labor and delivery in the United States. Among the possible complications of these procedures are prolonged surgical scar pain and prolonged pain at or near the epidural injection site. These can be difficult to treat and there is little in the literature detailing the efficacy of osteopathic manipulative treatment (OMT) or trigger-point injection therapy. Case: A 28-year-old G3P3 presented for persistent epidural site and surgical scar pain nine weeks after her third low transverse cesarean section (LTCS). Examination revealed significant segmental and myofascial somatic dysfunctions of the lumbar spine and abdomen. Pain to gentle palpation and paresthesia were noted over the LTCS scar. The patient was treated with OMT three times at approximately two-week intervals. The lumbar region was treated at all three visits and included myofascial release, muscle energy, and Still techniques. On the second and third visits, myofascial techniques were directed at the tissues deep to the LTCS scar in conjunction with trigger point injections. Results: After three treatments, the patient reported greater than 50% reduction in back pain, resolution of surgical scar pain, and greater than 60% reduction in scar paresthesia. She also noted that the pain in her back was no longer constant and that she could now tolerate clothing touching and even compressing the scar. Discussion: This patient’s response to OMT suggests that it is a viable treatment option for improving prolonged post-epidural site pain. It also suggests that OMT combined with trigger point injections is an effective treatment for prolonged surgical scar allodynia. Further research is needed to illustrate the efficacy of these modalities for the indications presented.