Opioid treatment and hypoalbuminemia are associated with increased hospitalisation rates in chronic pancreatitis outpatients

Olesen, Søren Schou; Poulsen, Jakob Lykke; Broberg, Marie; Madzak, Adnan; Drewes, Asbjørn Mohr

doi:10.1016/j.pan.2016.06.004

Cited by 30 publications

(10 citation statements)

References 32 publications

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“…1,2,4,9 The assessment and categorization of pain patterns was based on the patient's current perception of pain. The patients' pain pattern was characterized into the following categories according to a previously published classification 2 : (i) no pain, (ii) intermittent pain, (iii) constant pain, and (iv) constant pain with acute pain exacerbations.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4] Unfortunately, successful treatment of pain remains difficult and unsatisfactory in many cases, which is most likely explained by the complex and multifaceted underlying pain mechanisms. [1][2][3][4] Unfortunately, successful treatment of pain remains difficult and unsatisfactory in many cases, which is most likely explained by the complex and multifaceted underlying pain mechanisms.…”

Section: Introductionmentioning

confidence: 99%

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Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Olesen¹,

Kuhlmann

Novovic

et al. 2019

J of Gastro and Hepatol

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Background and Aim Pain is the primary symptom of chronic pancreatitis (CP) and associates with a number of patient and disease characteristics. However, the complex interrelations of these parameters are incompletely understood, and pain treatment remains unsatisfactory in a large proportion of patients. The aim of this study is to investigate multiple pain risk factors in a large population of CP patients, with a special emphasis on patients' patterns of smoking and alcohol use. Methods This was a multicenter, cross‐sectional study including 1384 patients with CP. Patient demographics and disease characteristics, as well as current patterns of smoking and alcohol use, were compared for patients with pain (n = 801) versus without pain (n = 583). Multivariate logistic regression models were performed to assess the variables associated with the presence and type of pain (constant vs intermittent pain). Results The mean age of participants was 52.1 ± 14.6 years, and 914 (66%) were men. Active smoking (odds ratio 1.6 [95% confidence interval 1.1–2.2], P = 0.005) and alcohol consumption (odds ratio 1.8 [95% confidence interval 1.1–3.0], P = 0.03) were independently associated with the presence of pain. In addition, patients' age at diagnosis, pancreatic duct pathology, and the presence of pseudocysts, duodenal stenosis, and exocrine pancreatic insufficiency were confirmed as pain risk factors (all P ≤ 0.01). Constant pain, as opposed to intermittent pain, was more frequently reported by smokers (P = 0.03), while alcohol consumption was associated with intermittent pain (P = 0.006). Conclusion Multiple patient and disease characteristics, including patterns of smoking and alcohol consumption, associate with the presence and type of pain in patients with CP.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Olesen¹,

Kuhlmann

Novovic

et al. 2019

J of Gastro and Hepatol

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“…As the disease progresses, exocrine and endocrine insufficiency may develop,2,3 necessitating treatment with antidiabetic medication and enzymatic supplementation. While these aforementioned complications are relatively straightforward to treat, chronic pain is more challenging and is associated with reduced quality of life and increased health resource utilization 4–6. In the patients where the underlying pathology is not amenable to endoscopic intervention or surgery, the treatment of pain is largely pharmacological in nature 7.…”

Section: Introductionmentioning

confidence: 99%

Acute physiological and electrical accentuation of vagal tone has no effect on pain or gastrointestinal motility in chronic pancreatitis

Juel¹,

Brock²,

Olesen³

et al. 2017

JPR

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BackgroundThe effective management of pain in chronic pancreatitis (CP) remains a therapeutic challenge. Analgesic drugs, such as opioids, and the underlying pathology can impair gut function. The autonomic nervous system influences hormone secretion and gut motility. In healthy volunteers, electrical (using noninvasive transcutaneous vagal nerve stimulation [t-VNS]) and physiological (using deep slow breathing [DSB]) modulation of parasympathetic tone results in pain attenuation and enhanced gut motility. Thus, the aims were to investigate whether t-VNS and DSB could enhance the parasympathetic tone, decrease pain sensitivity and improve gut motility in CP.Patients and methodsA total of 20 patients (12 males, mean age=61 years, range: 50–78 years) with CP were randomized to short-term (60 minutes) t-VNS and DSB, or their placebo equivalent, in a crossover design. Cardiometrically derived parameters of autonomic tone, quantitative sensory testing of bone and muscle pain pressure, conditioned pain modulation (CPM) and assessments of gastroduodenal motility with ultrasound were performed.ResultsIn comparison to sham, t-VNS and DSB increased cardiac vagal tone (CVT) (P<0.001). However, no changes in pain pressure thresholds for bone (P=0.95) or muscle (P=0.45) were seen. There was diminished CPM (P=0.04), and no changes in gastroduodenal motility were observed (P=0.3).ConclusionThis explorative study demonstrated that t-VNS and DSB increased CVT in patients with CP. However, this short-lasting increase did not affect pain sensitivity to musculoskeletal pain or gastroduodenal motility. The chronic pain in CP patients is complex, and future trials optimizing neuromodulation for pain relief and improved motility are needed.

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“… 54 Being present in up to 90% of the patients, 63 CP pain significantly increases the morbidity and reduces the life expectancy of affected patients, 87 and recent research has shown that pain is the most important factor to explain the reduced life quality and increased health resource utilization associated with the disease. 61 , 62 Clinically, the early stage of CP is typically dominated by pain attacks associated with recurrent episodes of pancreatitis and local or systemic complications, whereas in the advanced stage, pain is typically more constant. 54 Previously, it was believed that pain decreased over the time course of the disease, 1 but more recent studies have demonstrated that this is not the case in most patients.…”

Section: Introductionmentioning

confidence: 99%

Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment

Olesen

Krauss

Demir

et al. 2017

PR9

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Opioid treatment and hypoalbuminemia are associated with increased hospitalisation rates in chronic pancreatitis outpatients

Cited by 30 publications

References 32 publications

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Association of multiple patient and disease characteristics with the presence and type of pain in chronic pancreatitis

Acute physiological and electrical accentuation of vagal tone has no effect on pain or gastrointestinal motility in chronic pancreatitis

Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment

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