title: Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients.
abstract: OBJECTIVE
  Videoscopic splanchnicectomy (VSPL) is a method of pain relief in chronic pancreatitis patients. Because this method is not equally effective in all patients, this study was designed to identify the factors determining the unfavorable results of VSPL.
  
  
  METHODS
  This is a non-randomized prospective case-controlled study designed to compare a group of patients suffering from chronic pancreatitis treated with VSPL (N = 48) versus a group of patients treated symptomatically (N = 42). The outcome was measured as the intensity of pain ailments [visual analog scale (VAS)-pain scale] and subjective satisfaction of the patients from the surgical treatment [Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction (FACIT-TS)]. The predictive variables considered in this study were: age, sex, emotional status, social support (the two last variables were measured by subscales of quality-of-life questionnaire from the group of FACIT), history of previous surgical treatment, and opioid use for at least 3 months before VSPL. The follow-up was 18 months. Logistic regression was performed using dichotomized pain as outcome variable: high score more than 66.7 on VAS scale and low under 50 points on VAS scale 18 months after VSPL.
  
  
  RESULTS
  VSPL significantly reduced the pain ailments at all points of the study when compared to the control. However, the pain intensity at the end of the study was higher than directly after the surgery. In the patients treated with opioids before the surgery, the pain intensity was significantly higher than in the patients not using this group of drugs. Logistic regression revealed that opioid administration before VSPL was the most important predictor of high pain scores 18 months after the surgery.
  
  
  CONCLUSIONS
  When planning the VSPL in the treatment of pain in patients suffering from chronic pancreatitis, it is necessary to take into consideration the previous chronic use of opioids, as this variable can significantly influence poorer results of this surgical pain management.
authors: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland. wujstef@amg.gda.pl
authors: Tomasz
authors: T
authors: Stefaniak
authors: Ad
authors: A
authors: Vingerhoets
authors: Wojciech
authors: W
authors: Makarewicz
authors: Lukasz
authors: L
authors: Kaska
authors: Jarek
authors: J
authors: Kobiela
authors: Barbara
authors: B
authors: Kwiecińska
authors: Aleksander
authors: A
authors: Stanek
authors: Andrzej J
authors: AJ
authors: Lachinski
authors: Zbigniew
authors: Z
authors: Sledziński
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D010146:Pain / Q000601:surgery*; D010147:Pain Measurement / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D010179:Pancreas / Q000294:innervation; D050500:Pancreatitis, Chronic / Q000601:surgery*; D017060:Patient Satisfaction; D011300:Preoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D013153:Splanchnic Nerves / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid