Assessment of pain associated with chronic pancreatitis: An international consensus guideline

Drewes, Asbjørn Mohr; Veldhuisen, Charlotte L. van; Bellin, Melena D.; Besselink, Marc G.; Bouwense, Stefan; Olesen, Søren Schou; Santvoort, Hjalmar van; Vase, Lene; Windsor, John A.

doi:10.1016/j.pan.2021.07.004

Cited by 23 publications

(13 citation statements)

References 198 publications

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“…It's important to strive for a uniform assessment of pain in clinical studies, as this will increase the comparability of results. For further information on pain assessment in CP, please see the international guidelines on the subject ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

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Assessment of visceral pain with special reference to chronic pancreatitis

2022

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A thorough pain assessment is of utmost importance when managing pain in clinical practice as it is the foundation for defining pain in need of treatment, either interventional or pharmacological. Pain characteristics can also guide interventional strategies and help evaluate the effect of treatment. In research settings, standardized pain assessment is crucial to improve comparability across studies and facilitate meta-analysis. Due to the importance of thorough visceral pain assessment, this manuscript describes the key elements of pain evaluation focusing on chronic pancreatitis. Most studies in pain assessment have focused on somatic pain, and although chronic pain often shares characteristics between etiologies, some differences must be addressed when assessing visceral pain. Especially differences between somatic and visceral pain are apparent, where visceral pain is diffuse and difficult to localize, with referred pain aspects and often autonomic symptoms dominating the clinical picture. These aspects need to be incorporated into the pain assessment instrument. The manuscript will discuss the different ways of assessing pain, including unidimensional measurement scales, multidimensional questionnaires, and quantitative sensory testing. The advantages and challenges linked to the different methods will be evaluated.

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Section: Discussionmentioning

confidence: 99%

“…An international guideline for using different pain questionnaires and recommendations for their use in painful CP has recently been published. For further details, the reader is referred to ( 26 ).…”

Section: Pain Assessment Tools In Chronic Pancreatitismentioning

confidence: 99%

Assessment of visceral pain with special reference to chronic pancreatitis

2022

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“…Further, the resultant processed image quality also lacks quality, thereby necessitating the development of more robust tools for AI-driven tools for image segmentation and processing that may provide a better diagnostic accuracy [ 87 ]. In an interesting study [ 88 ], about 19,500 non-contrast CT scan images, acquired from 469 scans, were segmented using CNNs and the mean pancreatic tissue density, in terms of the Hounsfield unit (HU), as well as the pancreatic volume, were computed using the CNN algorithm. The comparison of the results of the pre-diagnostic scans from individuals who later developed PDAC and those that remained cancer-free, revealed that there was a significant reduction in the mean whole gland pancreatic HU of 0.2 vs. 7.8 in individuals who developed PDAC.…”

Section: Computed Tomographymentioning

confidence: 99%

Artificial Intelligence-Driven Diagnosis of Pancreatic Cancer

Hameed

Krishnan

2022

Cancers

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Pancreatic cancer is among the most challenging forms of cancer to treat, owing to its late diagnosis and aggressive nature that reduces the survival rate drastically. Pancreatic cancer diagnosis has been primarily based on imaging, but the current state-of-the-art imaging provides a poor prognosis, thus limiting clinicians’ treatment options. The advancement of a cancer diagnosis has been enhanced through the integration of artificial intelligence and imaging modalities to make better clinical decisions. In this review, we examine how AI models can improve the diagnosis of pancreatic cancer using different imaging modalities along with a discussion on the emerging trends in an AI-driven diagnosis, based on cytopathology and serological markers. Ethical concerns regarding the use of these tools have also been discussed.

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“…The diagnosis requires that the abdominal pain is typical and that there is either a significant elevation (≥threefold) of pancreatic enzymes (lipase or amylase) or pancreatic inflammatory changes on cross sectional imaging [1]. The assessment of pain is usually confined to pain intensity and a visual analogue scale (out of 10) is typically used [2], but it is notable that specific and validated scales have not been developed for pain assessment in acute pancreatitis as has been done for chronic pancreatitis [3]. Unfortunately, guidelines and recommendations for the management of pain in patients with acute pancreatitis do not provide clear and consistent guidance [4], and the approach is usually comparable to that used for other painful abdominal conditions.…”

Section: Introductionmentioning

confidence: 99%

Update on pain management in acute pancreatitis

Pandanaboyana

Huang

Windsor

et al. 2022

Current Opinion in Gastroenterology

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Purpose of reviewThis review discusses the analgesic options available from randomized controlled trials and recent systematic reviews. The evidence from other settings is considered and the evidence specific to acute pancreatitis emphasized. This highlights the options that are best supported by evidence but also the options that warrant further clinical trials.Recent findingsNonsteroidal anti-inflammatory drugs and paracetamol can provide adequate pain relief in patients with acute pancreatitis when compared with opioids. Epidural analgesia provides optimum pain relief in the first 24 h of onset of acute pancreatitis in addition to potential improvement in pancreatic perfusion. Several experimental analgesics and acupuncture have potential as opioid sparing strategies. Opioids are needed for patients with severe pain, to which adjuvant and experimental analgesics might be added.SummaryAmong the many options for pain management, the following principles should apply:tailor treatment to the individual patient (one size will not fit all);assess both pain intensity and pancreatitis severity when selecting analgesics;a step-down approach might be required achieve prompt pain relief (especially in patients with severe acute pancreatitis);use opioid sparing strategies whenever possible (especially in patients with mild acute pancreatitis); andpatients should be enrolled in much needed clinical trials where possible.

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Assessment of pain associated with chronic pancreatitis: An international consensus guideline

Cited by 23 publications

References 198 publications

Assessment of visceral pain with special reference to chronic pancreatitis

Assessment of visceral pain with special reference to chronic pancreatitis

Artificial Intelligence-Driven Diagnosis of Pancreatic Cancer

Update on pain management in acute pancreatitis

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