Pathogenesis of Pain in Chronic Pancreatitis: Ongoing Enigma

Abstract

The pathogenesis of pain in chronic pancreatitis remains an enigma. The cause of pain is almost certainly multifactorial and may vary at different stages of the disease process. These factors may include the release of excessive oxygen-derived free radicals, tissue hypoxia and acidosis, inflammatory infiltration with influx of pain transmittent substances into damaged nerve ends, and the development of pancreatic ductal and tissue fluid hypertension due to morphological changes of the pancreas. Investigations into the causes of pain have been limited by changes in the dynamics with the progression of the disease process, limitations in studying functional and morphological changes of the pancreas in the clinical setting, and the psychosomatic profile of patients. Many of these patients are addicted to alcohol, and suffer from personality disorders. The difficulty in quantifying pain, which is at best subjective, further compounds the issue, especially when assessing the efficacy of treatment.

EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review

“…Many theories have been proposed as to the pathogenesis of the abdominal pain associated with CP and pancreatic cancer. The possibilities include increased pressure within the pancreatic duct due to downstream obstruction [2], increased pressure within the pancreatic tissue [3,4], or neural alterations within the pancreas [5,6]. Genetic factors have also been proposed to play a role in the abdominal pain [7].…”

The pain of chronic pancreatitis: a persistent clinical challenge

“…22,23 Anatomical and morphological changes do not differ between those individuals with painful pancreatitis and those with painless pancreatitis. 24 Anaparthy and Pasricha 25 published an interesting review entitled 'Pain and chronic pancreatitis: is it the plumbing or the wiring? ', which explored not only empirical approaches aimed at relieving obstruction but also neuronal or 'wiring' causes for persistent pain in chronic pancreatitis.…”

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

“…The clinical management of these patients is particularly challenging. The repetitive inflammatory insult to the gland often results in intractable, refractory abdominal pain that produces a poor quality of life despite maximal medical management (1). End-stage pancreatitis is often characterized by heterotopic calcification of the pancreatic ducts that are thought to cause functional obstruction of the exocrine portion of the gland.…”