title: Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group.
abstract: METHODS
  Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking.
  
  
  METHODS
  Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement.
  
  
  RESULTS
  Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking.
  
  
  RESULTS
  There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies.
  
  
  CONCLUSIONS
  Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Venkata
authors.initials: V
authors.lastname: Akshintala
authors.affiliation: Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Albers
authors.affiliation: North Mississippi Medical Center, Tupelo, MS, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Amann
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Inna
authors.initials: I
authors.lastname: Belfer
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Brand
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Chari
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Cote
authors.affiliation: Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Davis
authors.affiliation: Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Frulloni
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.affiliation: Department of Gastroenterology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA.
authors.forename: Nalini
authors.initials: N
authors.lastname: Guda
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.affiliation: Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Rodger A
authors.initials: RA
authors.lastname: Liddle
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Rachelle Stopczynski
authors.initials: RS
authors.lastname: Gupta
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Szigethy
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jyothsna
authors.initials: J
authors.lastname: Talluri
authors.affiliation: Department of Medicine, University of Massachusetts, Worcester, MA, USA.
authors.forename: Wahid
authors.initials: W
authors.lastname: Wassef
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Windsor
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology & Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D050500:Pancreatitis, Chronic / Q000150:complications*; D017410:Practice Guidelines as Topic
chemical_list: D000700:Analgesics
keywords: Chronic pain; Chronic pancreatitis; Inflammation; Pancreatic surgery; Quality of life; Therapeutic endoscopy