title: Pain sensation in pancreatic diseases is not uniform: the different facets of pancreatic pain.
abstract: OBJECTIVE
  To systematically characterize specific pain patterns in the most frequent pancreatic diseases.
  
  
  METHODS
  Pain in patients with chronic pancreatitis (n = 314), pancreatic cancer (n = 469), and other pancreatic tumors (n = 249) including mucinous (n = 20) and serous cystadenoma (n = 31), invasive (n = 37) and non-invasive intraductal papillary mucinous neoplasia (IPMN; n = 48), low stage (n = 18) and high stage neuroendocrine neoplasia (n = 44), and ampullary cancer (n = 51) was registered and correlated with clinicopathological data. Survival times were estimated by the Kaplan-Meier method. Patients alive at the follow-up time were censored. Survival curves were compared statistically using the log-rank test.
  
  
  RESULTS
  Forty-nine point one percent of pancreatic cancer patients revealed no pain, whereas in chronic pancreatitis only 18.3% were pain free. In contrary, moderate/severe pain was registered in 15.1% in pancreatic cancer patients that was increased in chronic pancreatitis with up to 34.2%. Serous cystadenoma was asymptomatic in most cases (58.1%), whereas 78.9% of all mucinous cystadenoma patients suffered pain. In neuroendocrine neoplasia pain was not a key clinical symptom since 64% of low stage neuroendocrine neoplasia and 59% of high stage neuroendocrine neoplasia patients were pain free. Cancer localization in the pancreatic body and patients with malignant pancreatic neoplasms were associated with more severe pain. Tumor grading and stage did not show any impact on pain. Only in pancreatic cancer, pain was directly associated with impaired survival.
  
  
  CONCLUSIONS
  Pancreatic pain depicts different patterns of abdominal pain sensation according to the respective pancreatic disorder and does not allow a unification of the term pancreatic pain.
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Jan G
authors.initials: JG
authors.lastname: D'Haese
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Hartel
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Ihsan Ekin
authors.initials: IE
authors.lastname: Demir
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Bergmann
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Jan G D'Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Güralp O
authors.initials: GO
authors.lastname: Ceyhan
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D016009:Chi-Square Distribution; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D010147:Pain Measurement; D058748:Pain Perception; D017288:Pain Threshold; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D059265:Visceral Pain / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology
keywords: Abdominal pain; Chronic pancreatitis; Intraductal papillary mucinous neoplasia; Pancreatic cancer; Pancreatic neoplasm
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