Pain patterns in chronic pancreatitis and chronic primary pain

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 22; no. 5; pp. 572 - 582
• Main Authors: Tuck, N.L., Teo, K., Kuhlmann, L., Olesen, S.S., Johnson, M., Bean, D.J., Rashid, U., MacCormick, A.D., Srikumar, G., Drewes, A.M., Windsor, J.A.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01-06-2022; Elsevier Limited
• Subjects: Abdomen; Abdominal Pain - etiology; Biopsychosocial model; Chronic pain; Chronic Pain - complications; Chronic pancreatitis; Cross-Sectional Studies; Cysts; Hospitals; Humans; Interdisciplinary aspects; Nervous system; Pain; Pain assessment; Pain Measurement - methods; Pain phenotypes; Pancreatitis; Pancreatitis, Chronic - complications; Patients; Phenotypes; Quality of Life; Questionnaires; Regression analysis; New Zealand; Denmark; Pain assessment; Biopsychosocial model; Chronic pancreatitis; Chronic pain; Pain phenotypes
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2022.04.016

Abdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator.
This cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes.
Patients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics.
Compared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent.
Within CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms.