Medical Management of Pain in Chronic Pancreatitis

Abstract

The medical management of pain in chronic pancreatitis continues to pose significant challenges for clinicians caring for these patients. There are increasing data, suggesting that pain in chronic pancreatitis is largely due to peripheral and central sensitization that evolves, over time, as a result of nociceptive afferent associated with chronic inflammation and fibrosis of the pancreas. In many instances, patients rapidly progress to requiring opioid analgesics for the adequate treatment of pain despite the unequivocal risks associated with the long-term use of these drugs. Centrally acting drugs, such as gabapentinoids, appear to be effective means of treating pain due to their inhibition of neurotransmitters involved in central sensitization, but side effects limit their use. The present review explores the evidence for various non-pharmacologic and pharmacologic treatments for pain in chronic pancreatitis.

Quality of Life and Pain in Patients With Chronic Pancreatitis

“…37,39,40 In many cases, patients rapidly progress to requiring opioid analgesia, despite the risks associated with its long-term use. 40 This may be one of the causes of correlations between the intensity of pain and its impact on QoL, which has been confirmed by the results of studies by Fitzsimmons et al 5 and Solomina et al, 41 which showed that patients who take opioids have a poorer QoL. 5,41 Pain management is the main and predominant therapeutic challenge in CP, requiring a biopsychosocial approach focusing on interventions tailored to the needs of the individual patient.…”

“…Chronic pancreatitis pain has both peripheral and central elements and is often due to nociceptive stimulation caused by chronic inflammation and fibrosis of the pancreas 37,39,40 . In many cases, patients rapidly progress to requiring opioid analgesia, despite the risks associated with its long-term use 40 .…”

“…Chronic pancreatitis pain has both peripheral and central elements and is often due to nociceptive stimulation caused by chronic inflammation and fibrosis of the pancreas 37,39,40 . In many cases, patients rapidly progress to requiring opioid analgesia, despite the risks associated with its long-term use 40 . This may be one of the causes of correlations between the intensity of pain and its impact on QoL, which has been confirmed by the results of studies by Fitzsimmons et al 5 and Solomina et al, 41 which showed that patients who take opioids have a poorer QoL 5,41 …”

Psychiatric Disease Susceptibility and Pain in Chronic Pancreatitis: Association or Causation?

“…Abdominal pain is the hallmark symptom of chronic pancreatitis (CP), affecting more than 80% of patients, is associated with lower quality of life and is difficult to treat for several reasons (1). First, there are no accurate diagnostic tests that enable clinicians to differentiate between highly prevalent functional gastrointestinal disorders (2) and early CP (3,4).…”