Pathophysiology of pain in chronic pancreatitis: clinical implications from a surgical perspective

Pain is the main symptom and the major indication for surgery in a large proportion of patients with chronic pancreatitis. Since the characters of pain (including frequency, severity, duration and cause) differ among the patients with chronic pancreatitis, their management remains a difficult and challenging problem. Initial treatment is always conservative and may require a multidisciplinary approach involving gastroenterologist, anesthesiologist, psychologist for chemical addiction (alcohol and/or narcotics), and surgeon. When non-operative management fails to achieve pain relief and pain markedly alters quality of life, surgery should be considered. A thorough knowledge of the pathophysiology of pain offers the theoretical basis for both conservative and surgical treatment of chronic pancreatitis. The selection of the surgical procedure should be based on the structural changes of the pancreas.