title: Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure.
abstract: BACKGROUND
  Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.
  
  
  METHODS
  All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis.
  
  
  RESULTS
  A total of 60 patients (age 51.6 years, 53% males) were included in our study, of whom 42 (70%) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62%) patients with toxic etiology, 36 (60%) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p < 0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95% CI 1.3, 24.5, p = 0.02).
  
  
  CONCLUSIONS
  Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Amitasha
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Yuval A
authors.initials: YA
authors.lastname: Patel
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cruise
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Matsukuma
authors.affiliation: Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
authors.affiliation: Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Elham
authors.initials: E
authors.lastname: Afghani
authors.affiliation: Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
authors.affiliation: Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vsingh1@jhmi.edu.|Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vsingh1@jhmi.edu.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D002114:Calcinosis / Q000150:complications*; D004108:Dilatation, Pathologic / Q000150:complications; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010183:Pancreatic Ducts / Q000473:pathology; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects
keywords: Alcohol; Chronic pancreatitis; Post-operative pain relief; Smoking
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