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Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study
Marinus A Kempeneers1, Yama Issa1, Robert C Verdonk2
1Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands.
Gut
|November 7, 2020
Summary
Chronic pancreatitis pain patterns are not distinct entities but rather reflect pain severity. Pain characteristics change over time and are linked to pain intensity, not imaging or disease duration.
Area of Science:
- Gastroenterology
- Pain Medicine
- Clinical Research
Background:
- Chronic pancreatitis pain is often categorized into continuous or intermittent patterns.
- These patterns are presumed to represent different underlying conditions requiring distinct therapeutic approaches.
- Limited evidence exists to support these distinct pathophysiological entities.
Purpose of the Study:
- To investigate the characteristics and evolution of pain patterns in chronic pancreatitis.
- To determine if continuous and intermittent pain represent different pathophysiological entities.
- To assess factors associated with changes in pain patterns over time.
Main Methods:
- A prospective, longitudinal, nationwide study involving 1131 patients with chronic pancreatitis.
- Comparison of patients with continuous versus intermittent pain regarding demographics, pain, quality of life (Short-Form 36), imaging, disease duration, and treatment.
- Longitudinal assessment of pain pattern alternations using multivariable multinomial logistic regression.
Main Results:
- At baseline, 52% had continuous pain, 20% intermittent, and 28% no pain. Continuous pain was associated with higher severity, increased opioid/neuropathic medication use, and lower quality of life.
- No significant differences were observed in imaging findings, disease duration, or treatment between pain patterns.
- During a median follow-up of 47 months, 61% of patients switched pain patterns, primarily associated with Visual Analogue Scale pain intensity.
Conclusions:
- Continuous and intermittent pain in chronic pancreatitis likely do not stem from fundamentally different pathophysiological processes.
- The subjective experience of pain patterns is not directly correlated with imaging results or disease duration.
- Pain patterns are dynamic, frequently changing over time, and appear to be a manifestation of experienced pain severity.
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