title: Is altered central pain processing related to disease stage in chronic pancreatitis patients with pain? An exploratory study.
abstract: BACKGROUND
  The most dominant feature in chronic pancreatitis is intense abdominal pain. Changes in spinal and/or supraspinal central nervous system pain processing due to visceral nociceptive input play an important role in this pain. How altered pain processing is related to disease stage still needs study.
  
  
  RESULTS
  Sixty chronic pancreatitis patients were compared to 15 healthy controls. Two subgroups of pancreatitis patients were defined based on the M-ANNHEIM severity index of chronic pancreatitis; i.e. moderate and severe. Pain detection and tolerance thresholds for pressure and electric stimuli were measured in six selected dermatomes (C5, T4, T10, L1, L4 and T10BACK). In addition, the conditioned pain modulation response to cold pressor task was determined. These measures were compared between the healthy controls and chronic pancreatitis patients. Severe pancreatitis patients showed lower pain thresholds than moderate pancreatitis patients or healthy volunteers. Healthy controls showed a significantly larger conditioned pain modulation response compared to all chronic pancreatitis patients taken together.
  
  
  CONCLUSIONS
  The present study confirms that chronic pancreatitis patients show signs of altered central processing of nociception compared to healthy controls. The study further suggests that these changes, i.e. central sensitization, may be influenced by disease stage. These findings underline the need to take altered central pain processing into account when managing the pain of chronic pancreatitis.
authors: Pain and Nociception Neuroscience Research Group, Department of Surgery Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors: Stefan A W
authors: SA
authors: Bouwense
authors: Søren S
authors: SS
authors: Olesen
authors: Asbjørn M
authors: AM
authors: Drewes
authors: Jens B
authors: JB
authors: Frøkjær
authors: Harry
authors: H
authors: van Goor
authors: Oliver H G
authors: OH
authors: Wilder-Smith
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D000328:Adult; D016022:Case-Control Studies; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*