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Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.

Patients who experienced pain after surgery were administered a single dose of 1 of 3 treatments: acetaminophen 1000 mg, codeine phosphate 60 mg, or a combination of these. Patients rated their pain intensity on ordinal and visual analog scales just prior to medication and at intervals thereafter for up to 5 hours. They also rated pain relief, pain half gone, and any adverse effects. Sum of pain intensity difference and total pain relief scores were analyzed using Dunnett's procedure. The drug combination was statistically superior to codeine as measured by SPID, TOTPAR, pain half gone, and time to remedication. The combination achieved better mean scores than acetaminophen on all efficacy measures, but was (marginally) statistically superior only in pain half gone. No appreciable differences in adverse effects were noted among the treatments. The difficulty of showing the analgesic efficacy of codeine in a single dose trial is discussed.

Chronic pancreatitis has been defined by features that are clinical and etiologic in origin. From such definitions a number of classifications have been developed, starting with the Marseille Classification in 1963. Defining features of chronic pancreatitis must consider the etiology of the disease, which then presents characteristic clinical evidence through symptomatic sequelae of organ pathology, including complications of the disease. Advancing technology has improved the imaging capabilities available to document derangements of the pancreas. The main purpose of international classifications of disease states is to provide a common language for purposes of clinical, research, and health outcomes studies. Modification of the 10th World Health Organization I.C.D. classification may provide this tool.

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