Pharmacological management of pain in chronic pancreatitis

Pain is the major presenting symptom of chronic pancreatitis. Patients with chronic pancreatitis experience substantial impairments in health-related quality of life. Pain may be considered as the most important factor affecting the quality of life. The pathogenesis of pancreatic pain is poorly unde...

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Bibliographic Details
Published in:	Digestive and liver disease Vol. 38; no. 7; pp. 518 - 526
Main Authors:	van Esch, A.A.J., Wilder-Smith, O.H.G., Jansen, J.B.M.J., van Goor, H., Drenth, J.P.H.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-07-2006
Subjects:	Animals Chronic pain Chronic pancreatitis Diet Humans Oxidative Stress Pain - drug therapy Pain - etiology Pancreatic pain Pancreatitis, Chronic - complications Pancreatitis, Chronic - drug therapy Quality of Life Chronic pancreatitis Chronic pain Pancreatic pain
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Summary:	Pain is the major presenting symptom of chronic pancreatitis. Patients with chronic pancreatitis experience substantial impairments in health-related quality of life. Pain may be considered as the most important factor affecting the quality of life. The pathogenesis of pancreatic pain is poorly understood. The cause of pain in chronic pancreatitis is probably multifactorial. This article discusses the various hypotheses that have been suggested to underlie pain. Special attention is paid to the concept of autonomous central sensitisation and hyperalgesia as a cause of pain. Strict abstinence from alcohol is the first step of chronic pancreatic pain management. As a second step, it is important to exclude treatable complications of chronic pancreatitis, such as pseudocysts. Symptomatic treatment with analgesics is often unavoidable in patients with chronic pancreatitis. Acetaminophen, non-steroidal anti-inflammatory drugs and eventually opioids are suitable. Several trials have been performed with pancreatic enzymes, but a meta-analysis demonstrated no significant benefit in terms of pain relief. The treatment of chronic pancreatic pain requires a multidisciplinary approach that tailors the various therapeutic options to meet the need of the individual patient.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	1590-8658 1878-3562
DOI:	10.1016/j.dld.2006.02.002