Pain in chronic pancreatitis

Pathogenesis of Pain in Chronic Pancreatitis: Ongoing Enigma

“…The time-honored view is that continued alcoholism is largely responsible for recurrent acute attacks and subsequent ongoing pain, as well as for failures after surgery. However, on close scrutiny of published series [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], the data on which this assumption is made are often poorly recorded or, in those series where this aspect was specifically addressed, conflicting reports have emerged [8,13,[15][16][17][18][19] (Table 1). Although it would appear that alcohol plays an important role in precipitating acute attacks during the early stages of the disease [9,13,14], the association is less convincing among patients with advanced disease.…”

“…However, on close scrutiny of published series [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20], the data on which this assumption is made are often poorly recorded or, in those series where this aspect was specifically addressed, conflicting reports have emerged [8, 13, 15, 16, 17, 18, 19] (Table 1). Although it would appear that alcohol plays an important role in precipitating acute attacks during the early stages of the disease [9, 13, 14], the association is less convincing among patients with advanced disease. A number of reasons have been offered to explain these variable reports.…”

“…There is a school of thought suggesting that the majority of patients with established chronic pancreatitis will develop progressive pancreatic insufficiency and that, with time, the pain tends to diminish or disappear, a phenomenon now commonly referred to as the “pancreatic burn‐out syndrome.” It has also been suggested that, by virtue of poor exocrine function and consequent decreased pancreatic secretion, the build‐up of pressure in the pancreatic duct and/or tissue pressure would be insufficient to cause pain. Whether pancreatic insufficiency and pain relief run a parallel course has become a subject of much debate, particularly with regard to treatment strategy [61, 62, 63, 64]. Those who favor conservative treatment argue that the long‐term outcome of surgery is no different than medical treatment, and that it is the burn‐out phenomenon that is responsible in the main for the pain relief observed after surgery [12, 65].…”

“…It has also been suggested that, by virtue of poor exocrine function and consequent decreased pancreatic secretion, the build-up of pressure in the pancreatic duct and/ or tissue pressure would be insufficient to cause pain. Whether pancreatic insufficiency and pain relief run a parallel course has become a subject of much debate, particularly with regard to treatment strategy [61][62][63][64]. Those who favor conservative treatment argue that the long-term outcome of surgery is no different than medical treatment, and that it is the burn-out phenomenon that is responsible in the main for the pain relief observed after surgery [12,65].…”

“…Those who favor conservative treatment argue that the long‐term outcome of surgery is no different than medical treatment, and that it is the burn‐out phenomenon that is responsible in the main for the pain relief observed after surgery [12, 65]. There is also evidence that pain relief is better when surgical drainage is carried out earlier rather than later [14, 66], and that such relief is associated with a delay in the deterioration of pancreatic function [66, 67]. It has to be assumed that these functional improvements must be due, at least in part, to the alleviation of mechanical obstruction of the pancreatic flow, but there are other reports where function deteriorates despite a successful drainage operation [31].…”