Towards a neurobiological understanding of pain in chronic pancreatitis: Mechanisms and implications for treatment

Søren S. Olesen, Theresa Krauss, Ihsan Ekin Demir, Oliver H. Wilder-Smith, Güralp O. Ceyhan, Pankaj Jay Pasricha, Asbjørn M. Drewes

Research output: Contribution to journalArticle

Abstract

Introduction: Chronic pancreatitis (CP) is a disease characterized by inflammation of the pancreas resulting in replacement of the normal functioning parenchyma by fibrotic connective tissue. This process leads to progressively impairment of exocrine and endocrine function and many patients develop a chronic pain syndrome. Objectives: We aimed to characterize the neurobiological signature of pain associated with CP and to discuss its implications for treatment strategies. Methods: Relevant basic and clinical articles were selected for review following an extensive search of the literature. Results: Pathophysiological changes in the peripheral (pancreatic gland) and central nervous system characterize the pain syndrome associated with CP; involved mechanisms can be broken down to 3 main branches: (1) peripheral sensitization, (2) pancreatic neuropathy, and (3) neuroplastic changes in the central pain pathways. Disease flares (recurrent pancreatitis) may accelerate the pathophysiological process and further sensitize the pain system, which ultimately results in an autonomous and self-perpetuating pain state that may become independent of the peripheral nociceptive drive. These findings share many similarities with those observed in neuropathic pain disorders and have important implications for treatment; adjuvant analgesics are effective in a subset of patients, and neuromodulation and neuropsychological interventions may prove useful in the future. Conclusion: Chronic pancreatitis is associated with abnormal processing of pain at the peripheral and central level of the pain system. This neurobiological understanding of pain has important clinical implications for treatment and prevention of pain chronification.

Original languageEnglish (US)
Article numbere625
JournalPain Reports
Volume2
Issue number6
DOIs
StatePublished - Nov 1 2017

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Chronic Pancreatitis
Pain
Therapeutics
Somatoform Disorders
Neuralgia
Chronic Pain
Pancreatitis
Connective Tissue
Analgesics
Pancreas
Central Nervous System
Inflammation

Keywords

  • Chronic pancreatitis
  • Mechanisms
  • Pain
  • Treatment

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Towards a neurobiological understanding of pain in chronic pancreatitis : Mechanisms and implications for treatment. / Olesen, Søren S.; Krauss, Theresa; Demir, Ihsan Ekin; Wilder-Smith, Oliver H.; Ceyhan, Güralp O.; Pasricha, Pankaj Jay; Drewes, Asbjørn M.

In: Pain Reports, Vol. 2, No. 6, e625, 01.11.2017.

Research output: Contribution to journalArticle

Olesen, Søren S. ; Krauss, Theresa ; Demir, Ihsan Ekin ; Wilder-Smith, Oliver H. ; Ceyhan, Güralp O. ; Pasricha, Pankaj Jay ; Drewes, Asbjørn M. / Towards a neurobiological understanding of pain in chronic pancreatitis : Mechanisms and implications for treatment. In: Pain Reports. 2017 ; Vol. 2, No. 6.
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