Is osteopathic treatment appropriate for a patient with multimorbidity?

Multimorbidity is the coexistence of two or more chronic diseases in the same person, without prioritization, in contrast to comorbidity, where the main disease is highlighted. Multimorbidity increases the burden of medication, significantly impairing the quality of life of patients, which prompts the search for additional non-drug methods of care. Osteopathic correction can have a positive effect on the main pathogenetic links of diseases, among which are biomechanical and neurogenic manifestations of somatic dysfunction (SD), as well as on emotionalaffective disorders, functional disorders of segmental and suprasegmental autonomic structures, nociceptive and antinociceptive systems. In the treatment of patients with diseases of the nervous system, the literature notes the effectiveness of osteopathic correction in a comprehensive approach, including those confirmed by neurophysiological and neuroimaging methods. However, data regarding the effectiveness of osteopathic treatment in multimorbid patients are insufficient. We present a clinical case demonstrating the possibilities of osteopathic treatment in a patient with multimorbidity — with focal reflex epilepsy, classical migraine with aura, combined with chronic tension headache and nonspecific chronic musculoskeletal pain. Each of her chronic conditions requires medication intervention: focal reflex epilepsy — constant administration of anticonvulsant medication, migraine attacks, chronic tension headache and musculoskeletal pain — management with non-steroidal anti-inflammatory drugs and/or analgesics. Also background — anxiety is noted, she is consulted by a psychologist and periodically takes anxiolytics (tranquilizers). In our opinion, among the complex of factors contributing to the realization of diseases of the nervous system, including epilepsy, trigeminovascular syndromes, chronic tension headache, chronic musculoskeletal pain in the neck and upper back, there may be morphological and functional features of the skull and associated tissues and structures, in addition to the main and other causes. In the present clinical case, the patient had several regional SD identified on osteopathic examination. The dominant biomechanical disorder is the head region SD, and in the structure of this regional disorder the most attention was attracted by: SD of the sphenobasillary synchondrosis of the lateroflexion with rotation (SBR) type and SD of the right temporal bone. The first osteopathic procedure with correction of the head region in general and the temporal bone in particular resulted in a significant improvement of the patient′s condition. Background headache, pain in the neck and lumbar region disappeared, the patient began to feel alert, increased activity and improved mood. Retrospectively, epilepsy and migraine attacks are rare, chronic tension headaches and nonspecific chronic neck and back pain are also rare.
Conclusion. The present clinical example is illustrative, as it demonstrates the appropriateness and relative efficacy of osteopathic treatment in a particular patient with several chronic diseases of the nervous system.

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