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Pain management in chronic pancreatitis: A treatment algorithm.
Shailendra Chauhan1, Chris E Forsmark
1University of Florida, 32610-0214, United States.
Best Practice & Research. Clinical Gastroenterology
|June 1, 2010
Summary
Chronic pancreatitis pain management involves medical, endoscopic, and surgical options. Surgery is often more effective than endoscopy for dilated pancreatic ducts, with other interventions reserved for refractory cases.
Area of Science:
- Gastroenterology
- Pancreatology
Background:
- Chronic pancreatitis frequently causes debilitating abdominal pain.
- Initial management includes lifestyle changes and medical therapies like analgesics and pancreatic enzymes.
- Interventional options depend on pancreatic ductal anatomy.
Purpose of the Study:
- To review the management strategies for abdominal pain in chronic pancreatitis.
- To outline the indications and efficacy of various endoscopic and surgical interventions.
Main Methods:
- Review of medical, endoscopic, and surgical treatment modalities for chronic pancreatitis pain.
- Analysis of patient selection criteria based on pancreatic ductal anatomy.
- Comparison of endoscopic versus surgical therapy outcomes.
Main Results:
- Medical therapy is the first line, with pancreatic enzymes and antioxidants as adjunctive options.
- Endoscopic and surgical therapies are viable for dilated pancreatic ducts, including decompression or resection.
- Surgical therapy demonstrates superior durability and effectiveness compared to endoscopic therapy in randomized trials.
Conclusions:
- Treatment selection for chronic pancreatitis pain hinges on ductal anatomy and patient selection.
- Surgical interventions offer more durable pain relief for suitable candidates with chronic pancreatitis.
- Advanced procedures are reserved for highly selected, refractory cases.
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