title: Pharmacological pain management in chronic pancreatitis.
abstract: Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.
authors.affiliation: Søren S Olesen, Jacob Juel, Asbjørn M Drewes, Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark.
authors.forename: Søren S
authors.initials: SS
authors.lastname: Olesen
authors.forename: Jacob
authors.initials: J
authors.lastname: Juel
authors.forename: Carina
authors.initials: C
authors.lastname: Graversen
authors.forename: Yuri
authors.initials: Y
authors.lastname: Kolesnikov
authors.forename: Oliver H G
authors.initials: OH
authors.lastname: Wilder-Smith
authors.forename: Asbjørn M
authors.initials: AM
authors.lastname: Drewes
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D000700:Analgesics / Q000627:therapeutic use*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D058748:Pain Perception / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D010179:Pancreas / Q000294:innervation*; D050500:Pancreatitis, Chronic / Q000150:complications*; D010348:Patient Care Team; D018579:Patient Selection; D057285:Precision Medicine; D012307:Risk Factors; D016896:Treatment Outcome; D017833:Visceral Afferents / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D000700:Analgesics
keywords: Adjuvant analgesics; Analgesics; Chronic pancreatitis; Pain; Pharmacology; Treatment