title: 26. Pain in chronic pancreatitis.
abstract: Chronic pancreatitis is defined as a progressive inflammatory response of the pancreas that has lead to irreversible morphological changes of the parenchyma (fibrosis, loss of acini and islets of Langerhans, and formation of pancreatic stones) as well as of the pancreatic duct (stenosis and pancreatic stones). Pain is one of the most important symptoms of chronic pancreatitis. The pathogenesis of this pain can only partly be explained and it is therefore often difficult to treat this symptom. The management of pain induced by chronic pancreatitis starts with lifestyle changes and analgesics. For the pharmacological management, the three-step ladder of the World Health Organization extended with the use of co-analgesics is followed. Interventional pain management may consist of radiofrequency treatment of the nervi splanchnici, spinal cord stimulation, endoscopic stenting or stone extraction possibly in combination with lithotripsy, and surgery. To date, there are no randomized controlled trials supporting the efficacy of radiofrequency and spinal cord stimulation. The large published series reports justify a recommendation to consider these treatment options. Radiofrequency treatment, being less invasive than spinal cord stimulation, could be tested prior to considering spinal cord stimulation. There are several other treatment possibilities such as endoscopic or surgical treatment, pancreatic enzyme supplementation and administration of octreotide and antioxidants. All may have a role in the management of pain induced by chronic pancreatitis.
authors.affiliation: Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Puylaert
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.forename: Jan
authors.initials: J
authors.lastname: Van Zundert
authors.forename: Dirk
authors.initials: D
authors.lastname: Peek
authors.forename: Arno
authors.initials: A
authors.lastname: Lataster
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
authors.forename: Yolande C A
authors.initials: YC
authors.lastname: Keulemans
mesh_terms: D000465:Algorithms; D000700:Analgesics / Q000627:therapeutic use; D000758:Anesthesia; D002908:Chronic Disease; D056947:Enzyme Replacement Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D008019:Life Style; D009407:Nerve Block; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010186:Pancreatic Function Tests; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D010808:Physical Examination; D016896:Treatment Outcome
chemical_list: D000700:Analgesics