Interventional Pain Management Approaches for Control of Chronic Pancreatic Pain

Abstract

Treatment of persistent pain from chronic pancreatitis historically was difficult to treat. For years, focus was on opioid and other analgesics and psychological treatments. Recent studies provided evidence for decrease in analgesic intake and pain scores after properly conducted sympathetic blocks (celiac, splanchnic nerve blocks). These therapies should be considered as parts of a multimodal analgesic strategy. Animal studies suggest that spinal cord stimulation suppresses visceral hyperalgesia. Large case series of spinal cord stimulation demonstrated a significant pain relief in patients with chronic pancreatitis. Given the limitations of conservative and surgical treatments for chronic visceral pain, spinal cord stimulation may be a very useful therapeutic option.

An 18-Year-Old With Acute-on-Chronic Abdominal Pain

“…Lastly, neurogenic inflammation may result from tissue inflammation and cell death. 7 These sources of pancreatic pain create a challenge to provide adequate analgesia during each episode of pancreatitis, requiring treatments that target each subtype to create a multimodal approach while minimizing potential side effects. 8 Nociceptive pain can be managed with a combination of parenteral opioids and epidural analgesia, whereas nonsteroidal anti-inflammatory drugs reduce tissue inflammation.…”