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16. Pain in chronic pancreatitis
Laura van Zeggeren1, Raha Boelens Nabbi2, Jan Willem Kallewaard3,4
1Department of Anesthesiology and Pain Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
Summary
Managing chronic pancreatitis pain is complex, requiring a personalized approach. Effective strategies integrate medical, lifestyle, and psychological interventions, often guided by expert opinion due to limited clinical trials.
Area of Science:
- Gastroenterology
- Pain Medicine
- Pancreatology
Background:
- Chronic pancreatitis involves recurrent inflammation leading to fibrous tissue replacement.
- Pain in chronic pancreatitis has complex nociceptive, nociplastic, and neuropathic components.
- Central and peripheral sensitization, neuroplasticity, and neurogenic inflammation contribute to pain.
Purpose of the Study:
- To review and summarize the diagnosis and treatment of pain in chronic pancreatitis.
- To provide an overview of current management strategies for chronic pancreatitis pain.
Main Methods:
- Literature review on diagnosis and treatment of chronic pancreatitis pain.
- Synthesis of findings from observational studies and expert opinion.
Main Results:
- Treatment is guided by imaging, with obstructive disease managed endoscopically/surgically and non-obstructive disease medically.
- Analgesics range from non-opioids to opioids, with adjuvant agents and lifestyle changes crucial.
- Interventional options like radiofrequency ablation and spinal cord stimulation lack robust trial data but may offer opioid-sparing effects.
Conclusions:
- Pain management in chronic pancreatitis demands a multidimensional, individualized strategy.
- Treatment decisions often rely on expert consensus due to a lack of randomized trials.
- Integrating pharmacological, non-pharmacological, and multidisciplinary approaches is key for effective pain control.
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