How much do I know about hiccups? I do realise that hiccups are not caused by elves, as was thought in Olde England. I know that they are sometimes confusingly spelt hiccoughs, making me want to pronounce the word awkwardly as hick – offs. I have a hazy notion that the basic hiccup can be a result of gulping air with food (hence my stern exhortations to the children to keep their mouths shut whilst eating). I learnt at some point that the phrenic nerve was involved, causing the diaphragm to spasm, maybe in relation to excitement or nerves or very cold ice cream. Whatever the case, my mother’s tried and tested method of blocking the ears whilst drinking some water slowly from a cup has never failed to shift them. (Straw or willing helper are required.)
But what if the hiccups don’t go away? What if they become an intractable, ongoing source of discomfort and embarrassment? Could osteopathy help cure them?
Well, according to a case study in a recent IJOM it can, and it has – in this one instance at least. Here is the link to the actual study – A 25-year-old woman with 7 years of intractable hiccups treated with OMT – A case report, written by Derek E. Bowman and Christopher Pohlod, who are from Michigan State University College of Osteopathic Medicine. It is in the June 2024 edition of the International Journal of Osteopathic Medicine (IJOM). Nicely illustrated and very straightforward, with some interesting graphs and diagrams.
What are hiccups?
What is a hiccup? – the sudden, involuntary contraction of the diaphragm, followed by an abrupt closure of the glottis (vocal cords), producing the distinctive “hic” sound
Intractable hiccups
Persistent, intractable hiccups (i.e. lasting over 48 hours) are a difficult problem and are not well understood nor so easily cured. According to the authors, activation of a complex reflex arc is generally held responsible. This arc involves numerous nerves (phrenic, recurrent laryngeal, vagus et al.), central processing centres (C3-5 of spinal cord, medulla oblongata, midbrain…) and various neurotransmitters. The arc might be irritated, or otherwise dysregulated, due to medication side effects, central nervous system abnormalities or good old reflux. Treatments such as medication, hypnosis or acupuncture are hit and miss. In the worst cases, surgeons are called in and nerve blocks might be applied to the phrenic nerve. Sometimes the vagus nerve is stimulated.
The case in question
In this study, a 25 year old lady had been having over 50 hiccups a day for 7 years. No abnormalities were found on endoscopy or brain scan. A helicobacter pylori infection was discovered and treated successfully with no impact on symptoms. A number of further treatments were tried to no effect: acupuncture, relaxation, breathing, talking therapy, and finally, when the hiccups had morphed into a more painful and deep version of themselves, she resorted to a muscle relaxant, baclofen, which also failed to alleviate the problem. What to do? She was actually having fewer hiccups in number, however they were far worse in character.
Osteopathic treatment
Well, she turned to osteopathy. She had only 5 treatments in total. The plan was to treat diagnosed “somatic dysfunctions”1 using structural osteopathic techniques. These were balanced ligamentous tension, high-velocity low-amplitude thrusts, and muscle energy techniques, in the main. There were 3 treatments in August 2022, one at the end of September, and the final one in January 2023. Following the first treatment the patient experienced a brief, tingling warm sensation through the left median nerve distribution. The hiccups began to improve. After the third treatment, they were reduced to “micro-hiccups”; that is, almost imperceptible. In May 2023, months after treatment finished, she reported 1-2 micro-hiccups per week. I reckon if I monitored myself closely. I might have a couple of micro-hiccups a week.
Problems with the study
The authors head off obvious criticisms of the study well. To the most obvious criticism – that the hiccups were already in decline and their departure simply coincided with the timing of the treatments – they point to the 7 year history and the unlikeliness of their total departure (especially as they had actually become much more painful). They also highlight the patient’s report of specific release symptoms following the first treatment.
Conclusion
This was obviously a very successful outcome for this patient. Could this be repeated in other, similar cases? The authors conclude that this evidence certainly supports a potential role for osteopathic treatment in cases of intractable hiccups. Especially as it 1) carries very few few risks and 2) is comparatively inexpensive.
Thanks for reading, and do let me know if you have any similar successes with cases such as this
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