title: Systematic mechanism-orientated approach to chronic pancreatitis pain.
abstract: Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic intervention, often fails even if technically successful. If central nervous system pain processing is altered, specific treatment targeting these changes should be instituted (e.g., gabapentinoids, ketamine or tricyclic antidepressants). Suitable tools are now available to make altered central processing visible, including quantitative sensory testing, electroencephalograpy and (functional) magnetic resonance imaging. These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes. The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved. Future research should address the circumstances under which central nervous system pain processing changes in CP, and how this is influenced by ongoing nociceptive input and therapies. Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy, leading to improved treatment of chronic pain in CP and other visceral pain disorders.
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Stefan A W
authors.initials: SA
authors.lastname: Bouwense
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: de Vries
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Luuk T W
authors.initials: LT
authors.lastname: Schreuder
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Søren S
authors.initials: SS
authors.lastname: Olesen
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Jens B
authors.initials: JB
authors.lastname: Frøkjær
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Asbjørn M
authors.initials: AM
authors.lastname: Drewes
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Stefan AW Bouwense, Marjan de Vries, Luuk TW Schreuder, Harry van Goor, Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Medical Center, 6500HB Gelderland, The Netherlands.
authors.forename: Oliver H G
authors.initials: OH
authors.lastname: Wilder-Smith
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000818:Animals; D002490:Central Nervous System / Q000187:drug effects / Q000503:physiopathology; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D019091:Critical Pathways; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D058748:Pain Perception / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Central sensitization; Chronic pancreatitis; Electroencephalograpy; Magnetic resonance imaging; Pain; Pain treatment; Quantitative sensory testing