title: Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities.
abstract: Chronic pancreatitis (CP) has a profound independent effect on quality of life (QOL). Our aim was to identify factors that impact the QOL in CP patients.
  
  
  
  We used data on 1,024 CP patients enrolled in the three NAPS2 studies. Information on demographics, risk factors, co-morbidities, disease phenotype, and treatments was obtained from responses to structured questionnaires. Physical and mental component summary (PCS and MCS, respectively) scores generated using responses to the Short Form-12 (SF-12) survey were used to assess QOL at enrollment. Multivariable linear regression models determined independent predictors of QOL.
  
  
  
  Mean PCS and MCS scores were 36.7±11.7 and 42.4±12.2, respectively. Significant (P<0.05) negative impact on PCS scores in multivariable analyses was noted owing to constant mild-moderate pain with episodes of severe pain or constant severe pain (10 points), constant mild-moderate pain (5.2), pain-related disability/unemployment (5.1), current smoking (2.9 points), and medical co-morbidities. Significant (P<0.05) negative impact on MCS scores was related to constant pain irrespective of severity (6.8-6.9 points), current smoking (3.9 points), and pain-related disability/unemployment (2.4 points). In women, disability/unemployment resulted in an additional 3.7 point reduction in MCS score. Final multivariable models explained 27% and 18% of the variance in PCS and MCS scores, respectively. Etiology, disease duration, pancreatic morphology, diabetes, exocrine insufficiency, and prior endotherapy/pancreatic surgery had no significant independent effect on QOL.
  
  
  
  Constant pain, pain-related disability/unemployment, current smoking, and concurrent co-morbidities significantly affect the QOL in CP. Further research is needed to identify factors impacting QOL not explained by our analyses.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Machicado
authors.affiliation: North Mississippi Medical Center, Tupelo, Mississippi, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Amann
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Judah
authors.initials: J
authors.lastname: Abberbock
authors.affiliation: Indiana University, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Ohio State University, Columbus, Ohio, USA.
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Cote
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.affiliation: Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michele D
authors.initials: MD
authors.lastname: Lewis
authors.affiliation: Saint Louis University, St Louis, Missouri, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Alkaade
authors.affiliation: Richmond Gastroenterology Associates, Richmond, Virginia, USA.
authors.forename: Bimaljit S
authors.initials: BS
authors.lastname: Sandhu
authors.affiliation: Aurora Health Care, Milwaukee, Wisconsin, USA.
authors.forename: Nalini M
authors.initials: NM
authors.lastname: Guda
authors.affiliation: Yale School of Medicine, New Haven, Cincinnati, USA.
authors.forename: Thiruvengadam
authors.initials: T
authors.lastname: Muniraj
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Gong
authors.initials: G
authors.lastname: Tang
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: John
authors.initials: J
authors.lastname: Baillie
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Randall E
authors.initials: RE
authors.lastname: Brand
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Gardner
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.affiliation: University of Florida, Gainesville, Florida, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Forsmark
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology*; D000328:Adult; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D050500:Pancreatitis, Chronic / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data*