Altered central pain processing after pancreatic surgery for chronic pancreatitis

Bouwense, Stefan; Ali, Usama Ahmed; Broek, Richard P. G. ten; Issa, Yama; Eijck, Casper H. van; Wilder‐Smith, O. H. G.; Goor, Harry van

doi:10.1002/bjs.9322

Cited by 64 publications

(28 citation statements)

References 42 publications

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“…Not only can there be complications of disease including inflammation, obstruction (bile duct, pancreatic duct) as well as local complications including pseudocysts, local and central neuropathic changes also participate (2). Such neuropathic changes include central sensitization, impaired inhibitory pain modulation, as well as abnormalities of central pain processing (14-16). Given these changes, it may not be surprising then that no correlation between the imaging and pain pattern was identified.…”

Section: Discussionmentioning

confidence: 99%

Chronic Pancreatitis Pain Pattern and Severity Are Independent of Abdominal Imaging Findings

Wilcox

Yadav

Tian

et al. 2015

Clinical Gastroenterology and Hepatology

164

112

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Background & Aims Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. Methods We collected data from participants in North American Pancreatitis Study 2 Continuation and Validation, a prospective multicenter study of patients with chronic pancreatitis performed at 13 expert centers in the United States from July 2008 through March 2012. Chronic pancreatitis was defined based on detection of characteristic changes by cross-sectional abdominal imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, or histology analyses. Patients were asked by a physician or trained clinical research coordinator if they had any abdominal pain in the year before enrollment; those that responded “yes” were asked to select from a list of 5 pain patterns. Using these patterns, we classified patients’ pain based on timing and severity. Abnormal pancreatitis-associated features on abdominal imaging were recorded using standardized case report forms. Results Data were collected from 518 patients (mean age, 52±14.6 years; 55% male; and 87.6% white). The most common physician-identified etiologies were alcohol (45.8%) and idiopathic (24.3%); 15.6% of patients reported no abdominal pain in the year before enrollment. The most common individual pain pattern was described as constant mild pain with episodes of severe pain, reported in 45% of patients. The most common imaging findings included pancreatic ductal dilatation (68%), atrophy (57%), and calcifications (55%). Imaging findings were categorized as obstructive for 20% and inflammatory for 25% of cases. The distribution of individual imaging findings was similar among patients with different patterns of pain. The distribution of pain patterns did not differ among clinically relevant groups of imaging findings. Conclusions Mechanisms that determine patterns and severity of pain in patients with chronic pancreatitis are largely independent of structural variants observed by abdominal imaging techniques. Pancreas-relevant quantitative and qualitative pain measures should be included in the evaluation of patients with chronic pancreatitis, to assess pain severity independently of imaging findings.

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Section: Discussionmentioning

confidence: 99%

Chronic Pancreatitis Pain Pattern and Severity Are Independent of Abdominal Imaging Findings

Wilcox

Yadav

Tian

et al. 2015

Clinical Gastroenterology and Hepatology

164

112

View full text Add to dashboard Cite

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“…Olesen et al 66,68 explored patients with chronic pancreatitis, showing reduced CPM and central sensitization but low repeatability of CPM. Bouwense et al 7 found reduced CPM for these patients. Patients with whiplash-associated disorder had reduced CPM.…”

Section: Nociceptivementioning

confidence: 97%

Role of endogenous pain modulation in chronic pain mechanisms and treatment

Yarnitsky

2015

Pain

291

214

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Development and application of psychophysical test paradigms to assess endogenous pain modulation in healthy controls and in patients yielded large body of data over the last 2 decades. These tests can assist in predicting pain acquisition, in characterizing pain syndromes and related dysfunctions of pain modulation, and in predicting response to treatment. This chapter reviews the development of thought on pain modulation in the clinical setup, focusing on conditioned pain modulation, and update on accumulated data regarding the mechanism, protocols of administration, and applications in the clinic.

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“…Quantitative Sensory Testing (QST) is a validated and commonly used tool for evaluating central nociceptive processing 28. Treatment modalities that are directed at the nociceptive source (ie, the pain generator) can be expected to be less efficacious in the presence of central sensitization 29. Since no QST tests were used in this large cohort, this effect remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Bilateral distribution of anterior cutaneous nerve entrapment syndrome (ACNES): are clinical features and outcomes comparable to unilateral ACNES?

Maatman

Werner

Scheltinga

et al. 2019

Reg Anesth Pain Med

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Background and objectivesMirror-image pain may occur in the presence of a one-sided peripheral nerve lesion leading to a similar distribution of pain on the contralateral side of the body (“mirrored”). Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain syndrome due to entrapment of terminal branches of intercostal nerves T7–12 in the abdominal wall and sometimes presents bilaterally. This study aims to address specifics of bilateral ACNES and to determine potential differences in clinical presentation and treatment outcomes when compared with the unilateral form of ACNES.MethodsElectronic patient files and questionnaires of a case series of patients who were evaluated for chronic abdominal wall pain in a single center were analyzed using standard statistical methods.ResultsBetween June 1, 2011 and September 1, 2016, 1116 patients were diagnosed with ACNES, of which a total of 146 (13%) with bilateral ACNES were identified (female, n = 114, 78 %; median (range) age 36 (1181) years). Average NRS (Numeric Rating Scale; 0–10) scores were similar (median (range) NRS scores 6 (0–10) although peak NRS scores were significantly higher in the bilateral group (9 (5–10) vs 8 (2–10); p=0.02). After a median of 26 months (1–68), the proportion of patients with bilateral ACNES reporting treatment success was 61%.ConclusionsOne in eight patients with ACNES has bilateral abdominal wall pain. Characteristics are similar to unilateral ACNES cases. Further studies aimed at underlying mechanisms in mirror image pain pathogenesis could provide a more targeted approach in the management of this neuropathic pain.

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Altered central pain processing after pancreatic surgery for chronic pancreatitis

Cited by 64 publications

References 42 publications

Chronic Pancreatitis Pain Pattern and Severity Are Independent of Abdominal Imaging Findings

Chronic Pancreatitis Pain Pattern and Severity Are Independent of Abdominal Imaging Findings

Role of endogenous pain modulation in chronic pain mechanisms and treatment

Bilateral distribution of anterior cutaneous nerve entrapment syndrome (ACNES): are clinical features and outcomes comparable to unilateral ACNES?

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