Dhiraj Yadav1, Tonya M Palermo2, Anna E Phillips1, Melena D Bellin3, Darwin L Conwell4. 1. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington. 3. Division of Endocrinology and Metabolism, University of Minnesota Medical Center, Minneapolis, Minnesota. 4. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Abstract
PURPOSE OF REVIEW: Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis. RECENT FINDINGS: Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy. SUMMARY: Several lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
PURPOSE OF REVIEW: Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis. RECENT FINDINGS: Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy. SUMMARY: Several lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
Authors: Dhiraj Yadav; Robert H Hawes; Randall E Brand; Michelle A Anderson; Mary E Money; Peter A Banks; Michele D Bishop; John Baillie; Stuart Sherman; James DiSario; Frank R Burton; Timothy B Gardner; Stephen T Amann; Andres Gelrud; Christopher Lawrence; Beth Elinoff; Julia B Greer; Michael O'Connell; M Michael Barmada; Adam Slivka; David C Whitcomb Journal: Arch Intern Med Date: 2009-06-08
Authors: Asbjørn M Drewes; Stefan A W Bouwense; Claudia M Campbell; Güralp O Ceyhan; Myriam Delhaye; Ihsan Ekin Demir; Pramod K Garg; Harry van Goor; Christopher Halloran; Shuiji Isaji; John P Neoptolemos; Søren S Olesen; Tonya Palermo; Pankaj Jay Pasricha; Andrea Sheel; Tooru Shimosegawa; Eva Szigethy; David C Whitcomb; Dhiraj Yadav Journal: Pancreatology Date: 2017-07-13 Impact factor: 3.996
Authors: Kishore Vipperla; Allison Kanakis; Adam Slivka; Andrew D Althouse; Randall E Brand; Anna E Phillips; Jennifer Chennat; Georgios I Papachristou; Kenneth K Lee; Amer H Zureikat; David C Whitcomb; Dhiraj Yadav Journal: Pancreatology Date: 2021-02-02 Impact factor: 3.996
Authors: Joshua J Wilhelm; Appakalai N Balamurugan; Melena D Bellin; James S Hodges; Jessica Diaz; Sarah Jane Schwarzenberg; Zachary A Swanson; Marie E Cook; Elissa M Downs; David E R Sutherland; Bernhard J Hering; Srinath Chinnakotla Journal: Am J Transplant Date: 2020-08-28 Impact factor: 8.086
Authors: Guru Trikudanathan; B Joseph Elmunzer; Yi Yang; Maisam Abu-El-Haija; David Adams; Syed Ahmad; Appakalai N Balamurugan; Gregory J Beilman; Srinath Chinnakotla; Darwin L Conwell; Martin L Freeman; Timothy B Gardner; Betul Hatipoglu; James S Hodges; Varvara Kirchner; Luis F Lara; Leslie Long-Simpson; Rebecca Mitchell; Katherine Morgan; Jaimie D Nathan; Bashoo Naziruddin; Andrew Posselt; Timothy L Pruett; Sarah J Schwarzenberg; Vikesh K Singh; Kerrington Smith; Martin Wijkstrom; Piotr Witkowski; Melena D Bellin Journal: Pancreatology Date: 2020-11-24 Impact factor: 3.996
Authors: Louise Kuhlmann; Søren S Olesen; Debbie Grønlund; Anne E Olesen; Anna E Phillips; Mahya Faghih; Asbjørn M Drewes Journal: Clin J Pain Date: 2019-09 Impact factor: 3.442
Authors: Marinus A Kempeneers; Yama Issa; Robert C Verdonk; Marco Bruno; P Fockens; Harry van Goor; Eline Alofs; Thomas L Bollen; Stefan Bouwense; Anne S H M van Dalen; Susan van Dieren; Hendrik M van Dullemen; Erwin-Jan van Geenen; Chantal Hoge; Jeanin E van Hooft; Liesbeth M Kager; Yolande Keulemans; Lynn E Nooijen; Jan-Werner Poley; Tom C J Seerden; Adriaan Tan; Willem Thijs; Robin Timmer; Frank Vleggaar; Ben Witteman; Usama Ahmed Ali; Marc G Besselink; Marja A Boermeester; Hjalmar C van Santvoort Journal: Gut Date: 2020-11-06 Impact factor: 23.059