title: Morphologic abnormalities are poorly predictive of visceral pain in chronic pancreatitis.
abstract: OBJECTIVE
  Abdominal pain in chronic pancreatitis (CP) may be visceral or nonvisceral in origin. Differential nerve block (DNB) distinguishes visceral from nonvisceral pain. Endoscopic ultrasound and other imaging tests (eg, computed tomography and magnetic resonance cholangiopancreatography) are used to diagnose and stage CP. However, it is not known whether structural changes predict the presence of visceral pain, which may better respond to endoscopic, surgical, or visceral nerve interventions. We investigated the correlation of pancreatic structural abnormalities evident on imaging tests with the presence of visceral pain on DNB.
  
  
  METHODS
  A retrospective study was performed. Our DNB database was queried for patients who underwent imaging testing for evaluation of upper abdominal pain. The patients were classified into 3 groups based on structural severity: (1) normal pancreatic imaging, (2) mild CP, and (3) severe CP. The rates of visceral pain in the 3 groups were compared using a χ² test.
  
  
  RESULTS
  Fifty-four patients were included. There was no significant difference in rates of visceral pain based on structural severity: 48% in normal, 60% in mild CP, 67% in severe CP (χ², P = 0.484).
  
  
  CONCLUSIONS
  The severity of structural changes of CP found on imaging tests does not predict the presence of visceral pain.
authors: Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Rubin
authors: R
authors: Bahuva
authors: R Matthew
authors: RM
authors: Walsh
authors: Leonardo
authors: L
authors: Kapural
authors: Tyler
authors: T
authors: Stevens
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016009:Chi-Square Distribution; D049448:Cholangiopancreatography, Magnetic Resonance; D002908:Chronic Disease; D003952:Diagnostic Imaging / Q000379:methods; D019160:Endosonography; D006801:Humans; D009407:Nerve Block; D010147:Pain Measurement; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D059265:Visceral Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy