Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Yadav, Dhiraj; Askew, Robert L.; Palermo, Tonya M.; Li, Liang; Andersen, Dana K.; Chen, Minxing; Fisher, William E.; Fogel, Evan L.; Forsmark, Christopher E.; Hart, Phil A.; Othman, Mohamed O.; Pandol, Stephen J.; Park, Walter G.; Topazian, Mark D.; Eeden, Stephen K. Van Den; Vege, Santhi Swaroop; Yang, Yunlong; Serrano, José; Conwell, Darwin L.

doi:10.1016/j.cgh.2022.09.026

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…2 Pain is associated with comorbidities affecting quality of life (QOL) such as low physical activity, sleep problems, and symptoms of anxiety and depression, all of which are targets for treatment. 3 Many of the comorbid symptoms are modifiable with behavioral interventions; however, these have been sparsely used to date, and access to adequate behavioral health treatment has remained a common issue in this patient population. Both baseline assessment of disease symptoms-most commonly pain and related comorbid conditions-and the impact of interventions have remained a challenge to quantify and characterize in the absence of disease-specific tools that acknowledge both the complexity and the specific needs of this patient population.…”

Section: Behavioral Interventionsmentioning

confidence: 99%

“…22 Because pain is such a salient feature of CP (>80% over the course of disease, ~60% in the past week, 50% managed with chronic opioids), a standardized disease-specific pain assessment tool is needed to accurately identify pain profiles and also measure effectiveness of treatments. 3 Although pain remains a predominant feature of CP among all age groups, the pattern and impact on daily activities may differ. 23,24 An ideal pain assessment tool would have developmentally relevant versions applicable to children and adults to maintain consistency throughout trials across the lifespan.…”

Section: Disease-specific Assessment Of Pain In Cpmentioning

confidence: 99%

“…Pain is the most common symptom experienced in RAP and CP, is the main driver of disease morbidity, 1 and is the highest priority symptom identified by patients 2 . Pain is associated with comorbidities affecting quality of life (QOL) such as low physical activity, sleep problems, and symptoms of anxiety and depression, all of which are targets for treatment 3 . Many of the comorbid symptoms are modifiable with behavioral interventions; however, these have been sparsely used to date, and access to adequate behavioral health treatment has remained a common issue in this patient population.…”

Section: Behavioral Interventionsmentioning

confidence: 99%

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Interventions for Pancreatitis—New Approaches, Knowledge Gaps, and Research Opportunities

Phillips,

Hughes,

Andersen

et al. 2024

Pancreas

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There exists no cure for acute, recurrent acute or chronic pancreatitis and treatments to date have been focused on managing symptoms. A recent workshop held by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) focused on interventions that might disrupt or perhaps even reverse the natural course of this heterogenous disease, aiming to identify knowledge gaps and research opportunities that might inform future funding initiatives for NIDDK. The breadth and variety of identified active or planned clinical trials traverses the spectrum of the disease and was conceptually grouped for the workshop into behavioral, nutritional, pharmacologic and biologic, and mechanical interventions. Cognitive and other behavioral therapies are proven interventions for pain and addiction, but barriers exist to their use. Whilst a disease specific instrument quantifying pain is now validated, an equivalent is lacking for nutrition - and both face challenges in ease and frequency of administration. Multiple pharmacologic agents hold promise. Ongoing development of Patient Reported Outcome (PRO) measurements can satisfy Investigative New Drug (IND) regulatory assessments. Despite multiple randomized clinical trials demonstrating benefit, great uncertainty remains regarding patient selection, timing of intervention, and type of mechanical intervention (endoscopic versus surgery). Challenges and opportunities to establish beneficial interventions for patients were identified.

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Section: Behavioral Interventionsmentioning

confidence: 99%

Section: Disease-specific Assessment Of Pain In Cpmentioning

confidence: 99%

Section: Behavioral Interventionsmentioning

confidence: 99%

See 1 more Smart Citation

Interventions for Pancreatitis—New Approaches, Knowledge Gaps, and Research Opportunities

Phillips,

Hughes,

Andersen

et al. 2024

Pancreas

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“…Patients with severe or persistent pain in CP are more likely to experience psychological complications such as anxiety and depression. [51] These psychiatric comorbidities have a significant impact on the disease characteristics and quality of life of CP patients, manifested as higher pain incidence, greater pain severity, and poorer quality of life. [52] The studies indicate a bidirectional relationship between CP-related pain and psychiatric disorders.…”

Section: Clinical Assessment Of Abdominal Painmentioning

confidence: 99%

A comprehensive review of recent advances in chronic pancreatitis

Mao,

Zou,

Mao

et al. 2023

Journal of Pancreatology

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Chronic pancreatitis (CP) is a multifaceted disorder influenced by environmental and genetic factors, with smoking and alcohol consumption being major contributors. Recent developments encompass the advent of innovative transgenic models and the identification of susceptibility genes, shedding light on the genetic aspect of CP. The pathogenesis of this disease involves a complex interplay of pancreatic acinar cell dysfunction, inflammatory reactions, and fibrosis. Current research delves into understanding these molecular mechanisms. Pain, a pivotal symptom of CP, has been increasingly studied to develop effective therapeutic interventions. Diagnostic advancements, including endoscopic ultrasound, radiomics, and blood-based markers, have shown potential in enhancing early CP detection. Moreover, recent clinical trials have optimized treatment approaches, such as pancreatic stone fragmentation, stent placement, and decision-making between endoscopic and surgical procedures. Emerging therapies, including chemical pancreatectomy and gene therapy, present promising opportunities for improved CP management.

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“…[43] Another large US cohort study showed significant impairment in both physical and mental health in patients with severe or constant pain. [44] Interestingly, impairment in CP patients with pain also extended to disturbances in sleep, an aspect of life that may have further implications in worsening symptoms of anxiety and depression.…”

Section: Pain Effect On Mental Health and Qolmentioning

confidence: 99%

Recent advances in the understanding and management of chronic pancreatitis pain

Walker,

Babyok,

Saloman

et al. 2023

Journal of Pancreatology

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Abdominal pain is the most common symptom of chronic pancreatitis (CP), and is often debilitating for patients and very difficult to treat. To date, there exists no cure for the disease. Treatment strategies focus on symptom management and on mitigation of disease progression by reducing toxin exposure and avoiding recurrent inflammatory events. Traditional treatment protocols start with medical management followed by consideration of procedural or surgical intervention on selected patients with severe and persistent pain. The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders, exocrine pancreatic insufficiency, mineral bone disease, frailty, and malnutrition, are in their early stages. Recent clinical studies and animal models have been designed to improve investigation into the pathophysiology of CP pain, as well as to improve pain management. Despite the array of tools available, many therapeutic options for the management of CP pain provide incomplete relief. There still remains much to discover about the neural regulation of pancreas-related pain. In this review we will discuss research from the last five years that has provided new insights into novel methods of pain phenotyping and the pathophysiology of CP pain. These discoveries have led to improvements in patient selection for optimization of outcomes for both medical and procedural management, and identification of potential future therapies.

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Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Cited by 17 publications

References 26 publications

Interventions for Pancreatitis—New Approaches, Knowledge Gaps, and Research Opportunities

Interventions for Pancreatitis—New Approaches, Knowledge Gaps, and Research Opportunities

A comprehensive review of recent advances in chronic pancreatitis

Recent advances in the understanding and management of chronic pancreatitis pain

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