Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study

Abstract

ObjectivePain in chronic pancreatitis is subdivided in a continuous or intermittent pattern, each thought to represent a different entity, requiring specific treatment. Because evidence is missing, we studied pain patterns in a prospective longitudinal nationwide study.Design1131 patients with chronic pancreatitis (fulfilling M-ANNHEIM criteria) were included between 2011 and 2018 in 30 Dutch hospitals. Patients with continuous or intermittent pain were compared for demographics, pain characteristics, quality of life (Short-Form 36), imaging findings, disease duration and treatment. Alternation of pain pattern and associated variables were longitudinally assessed using a multivariable multinomial logistic regression model.ResultsAt inclusion, 589 patients (52%) had continuous pain, 231 patients (20%) had intermittent pain and 311 patients (28%) had no pain. Patients with continuous pain had more severe pain, used more opioids and neuropathic pain medication, and had a lower quality of life. There were no differences between pain patterns for morphological findings on imaging, disease duration and treatment. During a median follow-up of 47 months, 552 of 905 patients (61%) alternated at least once between pain patterns. All alternations were associated with the Visual Analogue Scale pain intensity score and surgery was only associated with the change from pain to no pain.ConclusionContinuous and intermittent pain patterns in chronic pancreatitis do not seem to be the result of distinctly different pathophysiological entities. The subjectively reported character of pain is not related to imaging findings or disease duration. Pain patterns often change over time and are merely a feature of how severity of pain is experienced.

Structural imaging findings are related to clinical complications in chronic pancreatitis

“… 1 , 7 , 34 On the other hand, persistence of pain has been observed in a significant fraction of patients after >10 years of disease, 34 , 35 and recently, a longitudinal study showed that pain patterns often fluctuate over time. 32 Pursuing registrations on indications for performing the imaging examination and pain registrations at the time of imaging, may provide more detailed knowledge on the roles of acute and possibly reversible structural changes in pancreatic pain. Furthermore, longitudinal data may provide novel information on temporal changes in pancreatic structural pathology and corresponding variations in pain.…”

Development of the Comprehensive Pain Assessment Tool Short Form for Chronic Pancreatitis: Validity and Reliability Testing

“…33 Fluctuating pain in CP has recently been confirmed and is similar to other kinds of visceral pain. 34 Therefore, reliability assessment is challenging in this patient group. Two groups were included to evaluate reliability.…”

Pain Sensitivity and Psychiatric Comorbidities in Chronic Pancreatitis Patients With and Without Pain: Past Experience Matters

“…Information on current alcohol consumption was registered as alcohol units consumed per week and organized into the following categories: abstainers, light-to-moderate, and heavy-or-very-heavy use. 2…”

“…C hronic pancreatitis (CP) is a fibroinflammatory disease of the pancreas, which manifests with abdominal pain in the majority of patients during their disease course. 1,2 There is a subset of patients, however, between 10% and 15%, who have "painless CP." This develops silently and is often either an incidental finding or is diagnosed in the workup of CP sequelae including exocrine pancreatic insufficiency or diabetes mellitus.…”

“…This information is important for clinical management, as pain is a dynamic process in CP, and many patients experience changes in their pain intensity and pain pattern over time. 2,6,8 Hence, when pain is successfully treated, it is unknown what occurs with either pain sensitivity or symptoms of psychologic distress experienced by patients. In other disorders such as recurrent low back pain and fibromyalgia, abnormal patterns of pain processing have been shown to change with dynamic pain experience, even returning to normal in some cases in the absence of pain.…”