Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities

Machicado, Jorge D.; Amann, Stephen T.; Anderson, Michelle A.; Abberbock, Judah; Sherman, Stuart; Conwell, Darwin L.; Coté, Gregory A.; Singh, Vikesh K.; Lewis, Michele D.; Alkaade, Samer; Sandhu, Bimaljit S.; Guda, Nalini M.; Muniraj, Thiruvengadam; Tang, Gong; Baillie, John; Brand, Randall E.; Gardner, Timothy B.; Gelrud, Andrés; Forsmark, Christopher E.; Banks, Peter A.; Slivka, Adam; Wilcox, C. Mel; Whitcomb, David C.; Yadav, Dhiraj

doi:10.1038/ajg.2017.42

Cited by 166 publications

(163 citation statements)

References 41 publications

Supporting

Mentioning

140

Contrasting

Unclassified

Order By: Relevance

“…The multivariate risk estimates for constant versus intermittent pain were directionally lower for all alcohol categories, while they were directionally higher for all smoking categories. 1,3 In keeping with this, constant pain and continued smoking are predictors of failed surgical treatment for painful CP. The finding may be explained by observations from a recent publication from our group where smoking was associated with development of fibrosis-related complications, while alcohol was associated with inflammatory-driven complications.…”

Section: Discussionmentioning

confidence: 85%

“…[1][2][3][4] Unfortunately, successful treatment of pain remains difficult and unsatisfactory in many cases, which is most likely explained by the complex and multifaceted underlying pain mechanisms. [1][2][3][4] Unfortunately, successful treatment of pain remains difficult and unsatisfactory in many cases, which is most likely explained by the complex and multifaceted underlying pain mechanisms.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Olesen¹,

Kuhlmann

Novovic

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim Pain is the primary symptom of chronic pancreatitis (CP) and associates with a number of patient and disease characteristics. However, the complex interrelations of these parameters are incompletely understood, and pain treatment remains unsatisfactory in a large proportion of patients. The aim of this study is to investigate multiple pain risk factors in a large population of CP patients, with a special emphasis on patients' patterns of smoking and alcohol use. Methods This was a multicenter, cross‐sectional study including 1384 patients with CP. Patient demographics and disease characteristics, as well as current patterns of smoking and alcohol use, were compared for patients with pain (n = 801) versus without pain (n = 583). Multivariate logistic regression models were performed to assess the variables associated with the presence and type of pain (constant vs intermittent pain). Results The mean age of participants was 52.1 ± 14.6 years, and 914 (66%) were men. Active smoking (odds ratio 1.6 [95% confidence interval 1.1–2.2], P = 0.005) and alcohol consumption (odds ratio 1.8 [95% confidence interval 1.1–3.0], P = 0.03) were independently associated with the presence of pain. In addition, patients' age at diagnosis, pancreatic duct pathology, and the presence of pseudocysts, duodenal stenosis, and exocrine pancreatic insufficiency were confirmed as pain risk factors (all P ≤ 0.01). Constant pain, as opposed to intermittent pain, was more frequently reported by smokers (P = 0.03), while alcohol consumption was associated with intermittent pain (P = 0.006). Conclusion Multiple patient and disease characteristics, including patterns of smoking and alcohol consumption, associate with the presence and type of pain in patients with CP.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Olesen¹,

Kuhlmann

Novovic

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…A model was constructed using the significant predictors of QOL for both RAP and chronic pancreatitis [28] to test whether the common predictor of lower QOL among subjects with RAP and chronic pancreatitis had differential effects based on diagnosis (i.e., to determine if the impact of a given predictor was greater for RAP or chronic pancreatitis). The only differential effect noted was for endocrine insufficiency on reducing the PCS score: the effect of endocrine insufficiency on PCS score was significantly greater among RAP subjects than chronic pancreatitis subjects (−4.9 vs. −1.28, p = 0.0184).…”

Section: Resultsmentioning

confidence: 99%

Recurrent Acute Pancreatitis Significantly Reduces Quality of Life Even in the Absence of Overt Chronic Pancreatitis

Coté

Yadav

Abberbock

et al. 2018

American Journal of Gastroenterology

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: The impact of recurrent acute pancreatitis (RAP) on quality of life (QOL) is unknown. We hypothesized that RAP would reduce QOL even in the absence of chronic pancreatitis (CP). METHODS: Data were pooled from three prospective, cross-sectional studies conducted across 27 U.S. centers (the North American Pancreatitis Studies); these included subjects with chronic pancreatitis (n = 1086), RAP alone (n = 508), and non-disease controls (n = 1025). QOL was measured using the Short Form 12 (SF-12), generating a Physical Component Summary (PCS) and the Mental Component Summary score (MCS). Multivariable regression models were developed to measure the effect of RAP on QOL, the predictors of lower QOL in those with RAP, and the differential effect QOL predictors between CP and RAP. RESULTS: Compared to controls (51.0 ±9.4), subjects with RAP (41.1 ± 11.4) and CP (37.2 ± 11.8) had lower PCS (p < 0.01). Subjects with CP had lower PCS compared to those with RAP (p < 0.01). Similarly, MCS was lower among RAP (44.6 ± 11.5) and CP (42.8 ± 12.2) subjects compared to controls (51.7 ± 9.1, p< 0.01). Subjects with CP had lower MCS compared to those with RAP (p < 0.01). After controlling for independent predictors of PCS, RAP was associated with lower PCS (estimate −8.46, p < 0.01) and MCS (estimate −6.45, p < 0.0001) compared to controls. The effect of endocrine insufficiency on PCS was differentially greater among RAP subjects (−1.28 for CP vs. −4.9 for RAP, p = 0.0184). CONCLUSIONS: Even in the absence of CP, subjects with RAP have lower physical and mental QOL. This underscores the importance of identifying interventions to attenuate RAP before the development of overt CP.

show abstract

“…CAP is experienced by almost 90% [123] of patients with chronic pancreatitis and half of them report having constant pain, which has a significant impact on QOL [124,125 ▪ ,126]. Neuropathic changes best correlate with pain in chronic pancreatitis [127].…”

Section: Central Sensitization In Chronic Pancreatitismentioning

confidence: 99%

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

Faghih

González

Makary³

et al. 2017

Current Opinion in Gastroenterology

View full text Add to dashboard Cite

Purpose of review Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. Recent findings The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. Summary The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery.

show abstract

Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities

Cited by 166 publications

References 41 publications

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Recurrent Acute Pancreatitis Significantly Reduces Quality of Life Even in the Absence of Overt Chronic Pancreatitis

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

Contact Info

Product

Resources

About