Resolution of Chemotherapy-Induced Intractable Hiccups Following Osteopathic Manipulative Treatment: A Case Report

Persistent hiccups are a rare but potentially debilitating complication of certain chemotherapeutic agents, particularly cisplatin, and may lead to sleep disruption, nutritional compromise, and decreased quality of life. Chemotherapy-induced hiccups are often refractory to conventional pharmacologic therapies, posing a clinical challenge in oncology care. We present the case of a 67-year-old man with moderately differentiated squamous cell carcinoma of the oropharynx who developed nearly continuous hiccups following his second cycle of cisplatin chemotherapy. Standard pharmacologic interventions, including metoclopramide, gabapentin, and a single dose of intravenous chlorpromazine, provided only transient or minimal relief. Osteopathic evaluation identified somatic dysfunctions involving the mid-cervical spine (C3-C5), upper thoracic segments, thoracic inlet, an elevated left first rib, restricted right hemidiaphragmatic excursion, and cranial base restrictions. These findings were considered potential contributors to altered diaphragmatic mechanics and dysregulation of the hiccup reflex arc. A single session of osteopathic manipulative treatment (OMT) directed at these regions was associated with rapid and complete resolution of hiccups, with sustained improvement in sleep, oral intake, and overall functional status. The patient tolerated subsequent chemotherapy cycles without recurrence of symptoms and did not require additional pharmacologic or osteopathic interventions. While causal inference cannot be established from a single case, this report suggests that OMT may serve as a safe adjunctive therapy for refractory chemotherapy-induced hiccups, potentially through effects on diaphragmatic motion, myofascial tension, and autonomic regulation.