title: Treatment options in painful chronic pancreatitis: a systematic review.
abstract: BACKGROUND
  Longlasting and unbearable pain is the most common and striking symptom of chronic pancreatitis. Accordingly, pain relief and improvement in patients' quality of life are the primary goals in the treatment of this disease. This systematic review aims to summarize the available data on treatment options.
  
  
  METHODS
  A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement for reporting systematic reviews and meta-analysis. The search was limited to randomized controlled trials and meta-analyses. Reference lists were then hand-searched for additional relevant titles. The results obtained were examined individually by two independent investigators for further selection and data extraction.
  
  
  RESULTS
  A total of 416 abstracts were reviewed, of which 367 were excluded because they were obviously irrelevant or represented overlapping studies. Consequently, 49 full-text articles were systematically reviewed.
  
  
  CONCLUSIONS
  First-line medical options include the provision of pain medication, adjunctive agents and pancreatic enzymes, and abstinence from alcohol and tobacco. If medical treatment fails, endoscopic treatment offers pain relief in the majority of patients in the short term. However, current data suggest that surgical treatment seems to be superior to endoscopic intervention because it is significantly more effective and, especially, lasts longer.
authors.affiliation: Department of Surgery, Rechts der Isar Clinic, Technical University of Munich, Munich, Germany.
authors.forename: Jan G
authors.initials: JG
authors.lastname: D'Haese
authors.forename: Güralp O
authors.initials: GO
authors.lastname: Ceyhan
authors.forename: Ihsan Ekin
authors.initials: IE
authors.lastname: Demir
authors.forename: Elke
authors.initials: E
authors.lastname: Tieftrunk
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
mesh_terms: D004724:Endoscopy / Q000009:adverse effects; D006801:Humans; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D059408:Pain Management / Q000009:adverse effects / Q000379:methods; D010180:Pancreatectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome
references.citation: Neuropsychopharmacology. 2008 Jul;33(8):1952-65
references.pmid: 17957217
references.citation: Ann Surg. 2008 Jun;247(6):950-61
references.pmid: 18520222
references.citation: Acta Chir Scand. 1990 Apr;156(4):309-15
references.pmid: 2349851
references.citation: Ann Surg. 1998 Dec;228(6):771-9
references.pmid: 9860476
references.citation: Surgery. 2012 Sep;152(3 Suppl 1):S95-S102
references.pmid: 22906892
references.citation: Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):281-98
references.pmid: 20510829
references.citation: Ann Surg. 2012 Apr;255(4):763-70
references.pmid: 22418009
references.citation: Cochrane Database Syst Rev. 2012 Jan 18;1:CD007884
references.pmid: 22258975
references.citation: Gastroenterology. 1984 Sep;87(3):746-7
references.pmid: 6745625
references.citation: Digestion. 1992;53(1-2):54-66
references.pmid: 1289173
references.citation: Am J Surg. 2008 Sep;196(3):364-72
references.pmid: 18513691
references.citation: Int J Pancreatol. 2000 Jun;27(3):235-40
references.pmid: 10952406
references.citation: Chirurg. 1995 Apr;66(4):350-9
references.pmid: 7634946
references.citation: Gastroenterology. 2011 Aug;141(2):536-43
references.pmid: 21683078
references.citation: Gastroenterology. 2009 Jan;136(1):177-186.e1
references.pmid: 18992743
references.citation: Arch Surg. 2012 Oct;147(10):925-32
references.pmid: 23117832
references.citation: Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):323-35
references.pmid: 20510832
references.citation: Br J Clin Pharmacol. 2012 Mar;73(3):363-72
references.pmid: 21950372
references.citation: Arch Surg. 2012 Oct;147(10):961-8
references.pmid: 23070412
references.citation: Am J Gastroenterol. 1996 Jul;91(7):1388-94
references.pmid: 8678001
references.citation: Gastrointest Endosc. 2009 Apr;69(4):835-42
references.pmid: 19136101
references.citation: Gut. 2007 Apr;56(4):534-44
references.pmid: 17047099
references.citation: Dig Dis Sci. 1999 Jun;44(6):1107-16
references.pmid: 10389680
references.citation: Aliment Pharmacol Ther. 1990 Aug;4(4):357-71
references.pmid: 2103755
references.citation: Aliment Pharmacol Ther. 2009 May 1;29(9):979-84
references.pmid: 19222416
references.citation: Clin Trials. 2009 Oct;6(5):455-63
references.pmid: 19737848
references.citation: Surg Endosc. 2008 Mar;22(3):580-8
references.pmid: 18163168
references.citation: Clin Gastroenterol Hepatol. 2012 Feb;10(2):186-91, 191.e1
references.pmid: 21946121
references.citation: J Clin Gastroenterol. 2006 Sep;40(8):721-5
references.pmid: 16940886
references.citation: World J Surg. 1990 Jan-Feb;14(1):70-6
references.pmid: 2407040
references.citation: Trials. 2010 Apr 29;11:47
references.pmid: 20429912
references.citation: Surgery. 2008 Apr;143(4):490-8
references.pmid: 18374046
references.citation: Surg Endosc. 2013 Oct;27(10):3639-45
references.pmid: 23572221
references.citation: Gastroenterology. 2008 May;134(5):1406-11
references.pmid: 18471517
references.citation: Surg Clin North Am. 1999 Aug;79(4):873-93
references.pmid: 10470333
references.citation: Ann Surg. 2007 Dec;246(6):966-74; discussion 974-5
references.pmid: 18043098
references.citation: Eur J Gastroenterol Hepatol. 2002 Sep;14(9):971-7
references.pmid: 12352216
references.citation: Ann Surg. 2005 Apr;241(4):591-8
references.pmid: 15798460
references.citation: Ann Surg. 1911 Jun;53(6):768-82
references.pmid: 17862691
references.citation: Pancreas. 1987;2(6):701-7
references.pmid: 3438308
references.citation: Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):311-22
references.pmid: 20510831
references.citation: PLoS One. 2012;7(8):e42096
references.pmid: 22879908
references.citation: Aliment Pharmacol Ther. 1992 Apr;6(2):229-40
references.pmid: 1600043
references.citation: Gastroenterology. 1980 Aug;79(2):289-93
references.pmid: 7399232
references.citation: N Engl J Med. 2007 Feb 15;356(7):676-84
references.pmid: 17301298
references.citation: Gastroenterology. 2011 Nov;141(5):1690-5
references.pmid: 21843494
references.citation: Clin J Pain. 2007 Mar-Apr;23(3):267-9
references.pmid: 17314587
references.citation: Br J Surg. 2012 Jun;99(6):761-6
references.pmid: 22434330
references.citation: Ann Surg. 1954 Dec;140(6):775-85
references.pmid: 13208131
references.citation: Br J Surg. 2008 Mar;95(3):350-6
references.pmid: 17933005
references.citation: Endoscopy. 2003 Jul;35(7):553-8
references.pmid: 12822088
references.citation: Am J Gastroenterol. 1997 Nov;92(11):2032-5
references.pmid: 9362186
references.citation: Am J Gastroenterol. 2009 Oct;104(10):2555-65
references.pmid: 19568227
references.citation: Arch Med Res. 1997 Autumn;28(3):387-90
references.pmid: 9291636
references.citation: Scand J Gastroenterol. 1990 May;25(5):462-6
references.pmid: 2359973
references.citation: Gastroenterology. 1993 May;104(5):1255-62
references.pmid: 8482439
references.citation: JOP. 2009 Sep 04;10(5):518-22
references.pmid: 19734628
references.citation: Aliment Pharmacol Ther. 2011 Oct;34(8):878-87
references.pmid: 21848870
references.citation: Surg Gynecol Obstet. 1978 Jun;146(6):959-62
references.pmid: 653575
references.citation: Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):243-9
references.pmid: 20510826
references.citation: Scand J Gastroenterol. 1985 Dec;20(10):1217-20
references.pmid: 3912959
references.citation: Ann Surg. 1960 Dec;152:1037-43
references.pmid: 13733040
references.citation: Am J Surg. 1997 Apr;173(4):257-63
references.pmid: 9136776
references.citation: Gastroenterology. 2007 Apr;132(4):1557-73
references.pmid: 17466744
references.citation: J Clin Gastroenterol. 2010 Feb;44(2):127-34
references.pmid: 19826273
references.citation: Endoscopy. 2002 Oct;34(10):765-71
references.pmid: 12244496
references.citation: Ann Surg. 1993 May;217(5):458-66; discussion 466-8
references.pmid: 8489308
references.citation: Dig Dis Sci. 1983 Feb;28(2):97-102
references.pmid: 6825540
references.citation: Ann Surg. 1995 Apr;221(4):350-8
references.pmid: 7726670
references.citation: AMA Arch Surg. 1958 Jun;76(6):898-907
references.pmid: 13532132
references.citation: Br J Surg. 1995 Sep;82(9):1270-3
references.pmid: 7552016
references.citation: Ann Surg. 2000 Mar;231(3):293-300
references.pmid: 10714621
references.citation: Curr Gastroenterol Rep. 2006 Apr;8(2):104-10
references.pmid: 16533472
references.citation: Pancreatology. 2009;9(4):344-50
references.pmid: 19451744
references.citation: Dig Dis. 2004;22(3):267-72
references.pmid: 15753609
references.citation: Pancreas. 2004 May;28(4):387-90
references.pmid: 15097855
references.citation: Gastroenterology. 2009 Jan;136(1):149-159.e2
references.pmid: 18952082
references.citation: JOP. 2005 Jan 13;6(1):6-12
references.pmid: 15650279
references.citation: Langenbecks Arch Surg. 2006 Aug;391(4):338-42
references.pmid: 16680474
references.citation: Ann Surg. 2006 Dec;244(6):909-18; discussion 918-20
references.pmid: 17122616
references.citation: Curr Opin Gastroenterol. 2007 Sep;23(5):502-7
references.pmid: 17762555
references.citation: World J Gastroenterol. 2010 Aug 28;16(32):4066-71
references.pmid: 20731021
references.citation: Int J Pancreatol. 1997 Dec;22(3):171-6
references.pmid: 9444547
references.citation: J Gastrointest Surg. 2006 Apr;10(4):499-503
references.pmid: 16627214
references.citation: Gastroenterology. 2012 Sep;143(3):655-663.e1
references.pmid: 22683257
references.citation: Scand J Gastroenterol. 1985 Dec;20(10):1249-54
references.pmid: 3912961
references.citation: Scand J Gastroenterol. 1995 Apr;30(4):392-8
references.pmid: 7610357
references.citation: Aliment Pharmacol Ther. 2009 Apr 1;29(7):706-19
references.pmid: 19284407
references.citation: Am J Gastroenterol. 2001 Feb;96(2):409-16
references.pmid: 11232683
references.citation: Gut. 2007 Apr;56(4):545-52
references.pmid: 17047101
references.citation: Gastrointest Endosc. 2002 Oct;56(4):501-6
references.pmid: 12297764
references.citation: Gut. 1995 Mar;36(3):450-4
references.pmid: 7698708
references.citation: Scand J Gastroenterol. 1986 Jan;21(1):104-8
references.pmid: 3633631
references.citation: Pancreas. 2012 Oct;41(7):1125-31
references.pmid: 22513290
references.citation: Dig Dis Sci. 2009 Nov;54(11):2330-7
references.pmid: 19137428
references.citation: World J Surg. 1990 Jan-Feb;14(1):53-8
references.pmid: 2407038
references.citation: Annu Rev Med. 1989;40:453-68
references.pmid: 2658760
references.citation: Best Pract Res Clin Gastroenterol. 2008;22(1):31-44
references.pmid: 18206811
references.citation: Am J Surg. 1995 Jan;169(1):65-9; discussion 69-70
references.pmid: 7818000
references.citation: Gastroenterol Clin North Am. 2007 Jun;36(2):335-64, ix
references.pmid: 17533083