Management of pancreatic pain

Treatment of pancreatic pain remains a very difficult problem. At present, when the main pancreatic duct is dilated, lateral pancreaticojejunostomy remains the treatment of choice for refractory pancreatic pain. When the disease is localized to the head or tail of the pancreas, resection of these segments has also proven to be effective in the majority of patients. It will be important to learn whether medical strategy (such as treatment with oral pancreatic enzymes or somatostatin) and endoscopic techniques (such as insertion of stents or shock-wave lithotripsy), compare favorably with surgical techniques. This evaluation will require randomized prospective trials.