Guidelines for the understanding and management of pain in chronic pancreatitis

for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis

Research output: Contribution to journalReview article

Abstract

Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories. For pain relief, current guidelines recommend a simple stepwise escalation of analgesic drugs with increasing potency until pain relief is obtained. Abstinence from alcohol and smoking should be strongly advised. Pancreatic enzyme therapy and antioxidants may be helpful as initial treatment. Endoscopic treatment can be used in patients with evidence of ductal obstruction and may be combined with extracorporeal shock wave lithothripsy. The best candidates are those with distal obstruction of the main pancreatic duct and in early stage of disease. Behavioral interventions should be part of the multidisciplinary approach to chronic pain management particularly when psychological impact is experienced. Surgery should be considered early and after a maximum of five endoscopic interventions. The type of surgery depends on morphological changes of the pancreas. Long-term effects are variable, but high success rates have been reported in open studies and when compared with endoscopic treatment. Finally, neurolytical interventions and neuromodulation can be considered in difficult patients.

Original languageEnglish (US)
Pages (from-to)720-731
Number of pages12
JournalPancreatology
Volume17
Issue number5
DOIs
StatePublished - Sep 2017

Keywords

  • Chronic pancreatitis
  • Pain treatment

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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    for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis (2017). Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology, 17(5), 720-731. https://doi.org/10.1016/j.pan.2017.07.006