Pancreatic Pain—Knowledge Gaps and Research Opportunities in Children and Adults

Abstract

A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to focus on research gaps and opportunities in pancreatic pain. The event was held on July 21, 2021, and structured into 4 sessions: (1) pathophysiology; (2) biomarkers, mediators, and pharmacology of pain; (3) pain assessment; and (4) pain treatment challenges and opportunities. The current state of knowledge was reviewed; many knowledge gaps and research needs were identified that require further investigation. Common themes included the need to better understand the underlying mechanisms of pain in pancreatic diseases, the relationship of visceral neural pathways and central pain centers, the role of behavioral factors and disorders on the perception of pain, and differences in pain perception and processes in children when compared with adults. In addition, the role of genetic risk factors for pain and the mechanisms and role of placebos in pain treatment were discussed. Methods of pain assessment including quantitative sensory testing were examined, as well as the process of central sensitization of pain. Finally, newer approaches to pain management including cognitive behavioral therapy, nerve stimulation, experimental (nonopioid) drugs, and cannabinoid compounds were covered.

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

“…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.…”

“…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.…”

“…As described in a previous workshop held by the NIDDK, 24 the Comprehensive Pain Assessment Tool for Chronic Pancreatitis (COMPAT), a self-administered research instrument specific to CP consisting of 6 pain dimensions, 25 has been made more useful through distillation into a short-form (COMPAT-SF) that can be completed in under 10 minutes at bedside. The COMPAT-SF includes 6 questions total that evaluate ( a ) pain severity, ( b ) pain pattern, ( c ) factors provoking pain, ( d ) widespread pain, and ( e ) qualitative pain descriptors 26 .…”