Does progressive pancreatic insufficiency limit pain in calcific pancreatitis with duct stricture or continued alcohol insult?

We studied the pancreatic function, alcohol history, and ERCP findings in 26 patients with painless and 34 patients with painful alcohol-induced calcific pancreatitis (AICP). About 50% of patients in both the painless and painful groups continued to take alcohol, the incidence of duct stricture or obstruction was of the order of 62% in both groups, and the proportion of patients with duct stricture or obstruction and continued alcohol intake was comparable. In all instances the patients in the painless category had significantly greater pancreatic insufficiency, or more impaired function, than patients with pain. This applied to those patients who continued to take alcohol, to those with an obstruction or stricture on ERCP, and to the subgroup with both duct narrowing and continued alcohol intake. We conclude that grossly impaired pancreatic function confers a degree of freedom from painful attacks in AICP in those patients who continue to drink even in the presence of duct obstruction or stricture on ERCP; and that patients with AICP become free of pancreatic pain once gross pancreatic insufficiency supervenes.