Pain in Chronic Pancreatitis: A Salutogenic Mechanism or a Maladaptive Brain Response?

Abstract

Pain in chronic pancreatitis is frequently refractory to medical and even surgical treatment. This refractoriness leads us to believe that a pancreas-independent, brain-mediated mechanism must be responsible. If so, several scenarios are worth considering. First, chronic pain could be the consequence of undesirable neuroplastic changes, by which pathology becomes established and causes disability. Alternatively, pain may be linked to the salutogenic (from salutogenesis, the Latin word for health and well-being) central nervous system response (we defined ‘salutogenic response’ as the specific modulation of the immune system induced by brain activity changes) to promote healing of the injured viscera. If so, chronic pain could index the ongoing nervous system attempt to promote healing. In this review, we discuss (1) the mechanisms of pain in chronic pancreatitis; (2) potential brain-related salutogenic mechanisms, and (3) the potential relationship of these two factors to the disease status. Furthermore, we consider these aspects in light of a new approach to treat visceral pain: transcranial magnetic stimulation, a noninvasive method of brain stimulation.

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

“…There are extensive data showing that, by decreasing acute pain, the chances to develop chronic pain are reduced since the mechanisms of maladaptive plasticity are limited. In fact, hyperactivity within pain-related neural areas often precedes chronic pain; and has been recently demonstrated [37,38]. Therefore, future longitudinal trials should also evaluate the long-term effects of tDCS on acute patients suffering from neuropathic pain after a SCI, or as a prophylactic treatment.…”

The pain of chronic pancreatitis: a persistent clinical challenge

“…Fregni and colleagues 30 have taken this concept further. They note that total pancreatectomy fails to relieve pain in up to 30% of chronic pancreatitis patients, 31 and use this as support for the notion that there must be a role for a pancreas-independent mechanism in the unremitting pain seen in chronic pancreatitis.…”

Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis

“…Once these complex mechanisms are present, the rationale for treatment approaches should also target central nervous system structures rather than using antiinflammatory agents alone. In fact, it has been speculated that changes in the central nervous system associated with chronic pain might promote peripheral inflammation (10). Importantly, central sensitization may possibly not be attenuated by reversing inflammation in the peripheral tissue (7), and, therefore, refractory pain may persist even after a total knee replacement.…”