Updates in endoscopic management of pain in chronic pancreatitis

This manuscript reviews recent updates on the management of pain in chronic pancreatitis, an entity that remains difficult to manage. In a time when opioid use disorder is on the rise, advanced endoscopists should be aware of the nonopioid options available to patients to help manage their pain.

Although there is no standardized approach in the management of pain in chronic pancreatitis, societal guidelines and recommendations have recently been updated to help guide physicians in this matter. However, the available endoscopic approaches have remained relatively unchanged in recent years. Studies are underway to determine whether one endoscopic approach is superior to another, depending on the suspected mechanism of pain.

Endoscopic management of pain in chronic pancreatitis remains challenging given the complex mechanisms at play. Surgery remains the most effective durable approach, though with significantly more morbidity and mortality compared to endoscopic options, which include endoscopic retrograde cholangiopancreatography (ERCP), extracorporeal shock wave lithotripsy (ESWL), pancreatoscopy-directed lithotripsy, and endoscopic ultrasound-guided celiac plexus block (EUS-CPB), depending on the predominant suspected cause of pain.