Outpatient Pain Management in Children With Chronic Pancreatitis

Abstract

ObjectivesAlthough pain management is central to pediatric chronic pancreatitis (CP) care, no evidence-based guidelines exist. In this scoping systematic review, we sought promising strategies for CP pain treatment in children.MethodsWe systematically reviewed literature on pain management in children and adults with CP, and 2 conditions with similar pain courses: juvenile idiopathic arthritis and sickle cell disease.ResultsOf 8997 studies identified, 287 met inclusion criteria. There are no published studies of analgesic medications, antioxidants, dietary modification, integrative medicine, or regional nerve blocks in children with CP. In adults with CP, studies of nonopioid analgesics, pancreatic enzymes, and dietary interventions have mixed results. Retrospective studies suggest that endoscopic retrograde cholangiopancreatography and surgical procedures, most durably total pancreatectomy with islet autotransplant, improve pain for children with CP. Follow-up was short relative to a child's life. Large studies in adults also suggest benefit from endoscopic therapy and surgery, but lack conclusive evidence about optimal procedure or timing. Studies on other painful pediatric chronic illnesses revealed little generalizable to children with CP.ConclusionsNo therapy had sufficient high-quality studies to warrant untempered, evidence-based support for use in children with CP. Multicenter studies are needed to identify pain management “best practices.”

Interventions for Pancreatitis—New Approaches, Knowledge Gaps, and Research Opportunities

“…3 Although pain remains a predominant feature of CP among all age groups, the pattern and impact on daily activities may differ. 23,24 An ideal pain assessment tool would have developmentally relevant versions applicable to children and adults to maintain consistency throughout trials across the lifespan.…”

“…Because pain is such a salient feature of CP (>80% over the course of disease, ~60% in the past week, 50% managed with chronic opioids), a standardized disease-specific pain assessment tool is needed to accurately identify pain profiles and also measure effectiveness of treatments 3 . Although pain remains a predominant feature of CP among all age groups, the pattern and impact on daily activities may differ 23,24 . An ideal pain assessment tool would have developmentally relevant versions applicable to children and adults to maintain consistency throughout trials across the lifespan.…”