Pain relief after Frey's procedure for chronic pancreatitis

Few studies have addressed long-term pain relief after Frey's procedure (local head resection with lateral pancreaticojejunostomy, LR-LPJ) for chronic pancreatitis. This retrospective study evaluated pain control using a validated score and risk factors associated with failure to achieve complete pain relief following LR-LPJ.

Sixty of 134 patients with chronic pancreatitis underwent LR-LPJ and were evaluated prospectively using the Izbicki pain score before surgery, and 1, 2, 5 and 7 years later. Analysis was on an intention-to-treat basis and predictors of complete pain relief were identified by multivariable analysis.

After a median follow-up of 6.4 years, the median pain score was reduced from 46.4 to 10.0 (P < 0.001) with partial or complete pain relief in 75 per cent of patients, and a significant reduction in median number of episodes requiring hospitalization (from 4 to 0; P < 0.001). Preoperative use of opiate medication (odds ratio (OR) 30.14; P = 0.015), continuous pattern of pain (OR 22.65; P = 0.025) and occurrence of postoperative complications (OR 10.52; P = 0.030) were significant predictors of failure to achieve complete pain relief after surgery.

Frey's procedure leads to significant and sustained long-term pain relief in patients with chronic pancreatitis. Patients should be referred for surgery before opiates are needed to relieve pain.