The course of chronic pancreatitis is prolonged, and pain is the main symptom, which seriously affects the quality of life and work ability of patients. Its treatment is the most important and complex problem. This article systematically describes the theoretical basis, indications, efficacy, selection and balance of drugs, endoscopy, surgery and other measures related to pain treatment.
Citation: WANG Wei. Treatment of pain in chronic pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(3): 285-293. doi: 10.7507/1007-9424.202112076 Copy
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3. | Lopez Gordo S, Busquets J, Peláez N, et al. Long-term results of resection of the head of the pancreas due to chronic pancreatitis: Pancreaticoduodenectomy or duodenum-preserving cephalic pancreatectomy? Cir Esp (Engl Ed), 2020, 98(5): 267-273. |
4. | Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J, 2017, 5(2): 153-199. |
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6. | Voiosu T, Boškoski I, Tringali A, et al. Chronic pancreatitis: an overview of diagnosis and management. Expert Rev Gastroenterol Hepatol, 2020, 14(7): 515-526. |
7. | Díte P, Ruzicka M, Zboril V, et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy, 2003, 35(7): 553-558. |
8. | Tillou JD, Tatum JA, Jolissaint JS, et al. Operative management of chronic pancreatitis: A review. Am J Surg, 2017, 214(2): 347-357. |
9. | Zhao X, Cui N, Wang X, et al. Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(9): e6220. doi: 10.1097/MD.0000000000006220. |
10. | Machicado JD, Chari ST, Timmons L, et al. A population-based evaluation of the natural history of chronic pancreatitis. Pancreatology, 2018, 18(1): 39-45. |
11. | Gardner TB, Adler DG, Forsmark CE, et al. ACG Clinical Guideline: chronic pancreatitis. Am J Gastroenterol, 2020, 115(3): 322-339. |
12. | Ru N, Xu XN, Cao Y, et al. The impacts of genetic and environmental factors on the progression of chronic pancreatitis. Clin Gastroenterol Hepatol, 2021, S1542-3565(21): 00913-7. doi: 10.1016/j.cgh.2021.08.033. Onlineaheadofprint. |
13. | Iodice S, Gandini S, Maisonneuve P, et al. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch Surg, 2008, 393(4): 535-545. |
14. | Ueda J, Tanaka M, Ohtsuka T, et al. Surgery for chronic pancreatitis decreases the risk for pancreatic cancer: a multicenter retrospective analysis. Surgery, 2013, 153(3): 357-364. |
15. | Drewes AM, Kempeneers MA, Andersen DK, et al. Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons! Gut, 2019, 68(8): 1343-1351. |
16. | Hu LH, Ye B, Yang YG, et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones: A prospective study of 214 cases. Pancreas, 2016, 45(2): 298-305. |
17. | Mendieta PJO, Sagae VMT, Ribeiro IB, et al. Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis. Surg Endosc, 2021, 35(8): 4085-4094. |
18. | Kempeneers MA, Issa Y, Ali UA, et al. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology, 2020, 20(2): 149-157. |
19. | Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684. |
20. | Cahen DL, Gouma DJ, Laramée P, et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology, 2011, 141(5): 1690-1695. |
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24. | Tringali A, Bove V, Vadalà di Prampero SF, et al. Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis. Endoscopy, 2019, 51(10): 930-935. |
25. | Willner A, Bogner A, Müssle B, et al. Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome. Medicine (Baltimore), 2020, 99(44): e22896. doi: 10.1097/MD.0000000000022896. |
26. | Wilcox CM, Yadav D, Ye T, et al. Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings. Clin Gastroenterol Hepatol, 2015, 13(3): 552-560. |
27. | Anderson MA, Akshintala V, Albers KM, et al. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology, 2016, 16(1): 83-94. |
28. | Olesen SS, Frøkjær JB, Lelic D, et al. Pain-associated adaptive cortical reorganisation in chronic pancreatitis. Pancreatology, 2010, 10(6): 742-751. |
29. | Bouwense SA, de Vries M, Schreuder LT, et al. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol, 2015, 21(1): 47-59. |
30. | Issa Y, Kempeneers MA, Bruno MJ, et al. Effect of early surgery vs endoscopy-first approach on pain in patients with chronic pancreatitis: The ESCAPE randomized clinical trial. JAMA, 2020, 323(3): 237-247. |
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34. | Ke N, Jia D, Huang W, et al. Earlier surgery improves outcomes from painful chronic pancreatitis. Medicine (Baltimore), 2018, 97(19): e0651. doi: 10.1097/MD.0000000000010651. |
35. | Yang CJ, Bliss LA, Freedman SD, et al. Surgery for chronic pancreatitis: the role of early surgery in pain management. Pancreas, 2015, 44(5): 819-823. |
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- 2. Beyer G, Habtezion A, Werner J, et al. Chronic pancreatitis. Lancet, 2020, 396(10249): 499-512.
- 3. Lopez Gordo S, Busquets J, Peláez N, et al. Long-term results of resection of the head of the pancreas due to chronic pancreatitis: Pancreaticoduodenectomy or duodenum-preserving cephalic pancreatectomy? Cir Esp (Engl Ed), 2020, 98(5): 267-273.
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- 5. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—Updated August 2018. Endoscopy, 2019, 51(2): 179-193.
- 6. Voiosu T, Boškoski I, Tringali A, et al. Chronic pancreatitis: an overview of diagnosis and management. Expert Rev Gastroenterol Hepatol, 2020, 14(7): 515-526.
- 7. Díte P, Ruzicka M, Zboril V, et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy, 2003, 35(7): 553-558.
- 8. Tillou JD, Tatum JA, Jolissaint JS, et al. Operative management of chronic pancreatitis: A review. Am J Surg, 2017, 214(2): 347-357.
- 9. Zhao X, Cui N, Wang X, et al. Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(9): e6220. doi: 10.1097/MD.0000000000006220.
- 10. Machicado JD, Chari ST, Timmons L, et al. A population-based evaluation of the natural history of chronic pancreatitis. Pancreatology, 2018, 18(1): 39-45.
- 11. Gardner TB, Adler DG, Forsmark CE, et al. ACG Clinical Guideline: chronic pancreatitis. Am J Gastroenterol, 2020, 115(3): 322-339.
- 12. Ru N, Xu XN, Cao Y, et al. The impacts of genetic and environmental factors on the progression of chronic pancreatitis. Clin Gastroenterol Hepatol, 2021, S1542-3565(21): 00913-7. doi: 10.1016/j.cgh.2021.08.033. Onlineaheadofprint.
- 13. Iodice S, Gandini S, Maisonneuve P, et al. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch Surg, 2008, 393(4): 535-545.
- 14. Ueda J, Tanaka M, Ohtsuka T, et al. Surgery for chronic pancreatitis decreases the risk for pancreatic cancer: a multicenter retrospective analysis. Surgery, 2013, 153(3): 357-364.
- 15. Drewes AM, Kempeneers MA, Andersen DK, et al. Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons! Gut, 2019, 68(8): 1343-1351.
- 16. Hu LH, Ye B, Yang YG, et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones: A prospective study of 214 cases. Pancreas, 2016, 45(2): 298-305.
- 17. Mendieta PJO, Sagae VMT, Ribeiro IB, et al. Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis. Surg Endosc, 2021, 35(8): 4085-4094.
- 18. Kempeneers MA, Issa Y, Ali UA, et al. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology, 2020, 20(2): 149-157.
- 19. Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
- 20. Cahen DL, Gouma DJ, Laramée P, et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology, 2011, 141(5): 1690-1695.
- 21. Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review. JAMA, 2019, 322(24): 2422-2434.
- 22. Ma KW, So H, Shin E, et al. Endoscopic versus surgical intervention for painful obstructive chronic pancreatitis: a systematic review and meta-analysis. J Clin Med, 2021, 10(12): 2636. doi: 10.3390/jcm10122636.
- 23. Olesen SS, Krauss T, Demir IE, et al. Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment. Pain Rep, 2017, 2(6): e625. doi: 10.1097/PR9.0000000000000625.
- 24. Tringali A, Bove V, Vadalà di Prampero SF, et al. Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis. Endoscopy, 2019, 51(10): 930-935.
- 25. Willner A, Bogner A, Müssle B, et al. Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome. Medicine (Baltimore), 2020, 99(44): e22896. doi: 10.1097/MD.0000000000022896.
- 26. Wilcox CM, Yadav D, Ye T, et al. Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings. Clin Gastroenterol Hepatol, 2015, 13(3): 552-560.
- 27. Anderson MA, Akshintala V, Albers KM, et al. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology, 2016, 16(1): 83-94.
- 28. Olesen SS, Frøkjær JB, Lelic D, et al. Pain-associated adaptive cortical reorganisation in chronic pancreatitis. Pancreatology, 2010, 10(6): 742-751.
- 29. Bouwense SA, de Vries M, Schreuder LT, et al. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol, 2015, 21(1): 47-59.
- 30. Issa Y, Kempeneers MA, Bruno MJ, et al. Effect of early surgery vs endoscopy-first approach on pain in patients with chronic pancreatitis: The ESCAPE randomized clinical trial. JAMA, 2020, 323(3): 237-247.
- 31. Bouwense SA, Olesen SS, Drewes AM, et al. Is altered central pain processing related to disease stage in chronic pancreatitis patients with pain? An exploratory study. PLoS One, 2013, 8(2): e55460. doi: 10.1371/journal.pone.0055460.
- 32. Yang CJ, Bliss LA, Schapira EF, et al. Systematic review of early surgery for chronic pancreatitis: impact on pain, pancreatic function, and re-intervention. J Gastrointest Surg, 2014, 18(10): 1863-1869.
- 33. Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH, et al. Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg, 2012, 147(10): 925-932.
- 34. Ke N, Jia D, Huang W, et al. Earlier surgery improves outcomes from painful chronic pancreatitis. Medicine (Baltimore), 2018, 97(19): e0651. doi: 10.1097/MD.0000000000010651.
- 35. Yang CJ, Bliss LA, Freedman SD, et al. Surgery for chronic pancreatitis: the role of early surgery in pain management. Pancreas, 2015, 44(5): 819-823.
- 36. Olesen SS, Krarup H, Poulsen JL, et al. Pancreas-specific plasma amylase for assessment and diagnosis of chronic pancreatitis: New insights on an old topic. United European Gastroenterol J, 2019, 7(7): 955-964.
- 37. Kaufman M, Singh G, Das S, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol, 2010, 44(2): 127-134.
- 38. Stevens T, Costanzo A, Lopez R, et al. Adding triamcinolone to endoscopic ultrasound-guided celiac plexus blockade does not reduce pain in patients with chronic pancreatitis. Clin Gastroenterol Hepatol, 2012, 10(2): 186-191.
- 39. Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med, 1993, 328(20): 1433-1437.
- 40. Shelton CA, Umapathy C, Stello K, et al. Hereditary pancreatitis in the United States: survival and rates of pancreatic cancer. Am J Gastroenterol, 2018, 113(9): 1376. doi: 10.1038/s41395-018-0194-5.
- 41. Wang W, Liao Z, Li G, et al. Incidence of pancreatic cancer in chinese patients with chronic pancreatitis. Pancreatology, 2011, 11(1): 16-23.
- 42. 王伟, 王剑, 李兆申, 等. 慢性胰腺炎的胰腺癌发生率及风险因素分析. 中华消化杂志, 2009, 29(2): 93-96.
- 43. Gupte A, Goede D, Tuite R, et al. Chronic pancreatitis. BMJ, 2018, 361: k2126. doi: 10.1136/bmj.k2126.
- 44. Munigala S, Kanwal F, Xian H, et al. New diagnosis of chronic pancreatitis: risk of missing an underlying pancreatic cancer. Am J Gastroenterol, 2014, 109(11): 1824-1830.
- 45. Malinka T, Klein F, LE Thu T, et al. A Bi-national analysis of 252 pancreatic resections for chronic pancreatitis with regard to incidental carcinoma sequence and overall postoperative outcome. Anticancer Res, 2018, 38(8): 4947-4952.
- 46. Birgin E, Hablawetz P, Téoule P, et al. Chronic pancreatitis and resectable synchronous pancreatic carcinoma: A survival analysis. Pancreatology, 2018, 18(4): 394-398.
- 47. Mahesh S, Lekha V, Manipadam JM, et al. What can be done when the cored specimen in a Frey procedure for chronic pancreatitis is reported as adenocarcinoma? Indian J Gastroenterol, 2016, 35(6): 486-488.
- 48. Abu-El-Haija M, Anazawa T, Beilman GJ, et al. The role of total pancreatectomy with islet autotransplantation in the treatment of chronic pancreatitis: A report from the International Consensus Guidelines in chronic pancreatitis. Pancreatology, 2020, 20(4): 762-771.
- 49. Najarian JS, Sutherland DE, Matas AJ, et al. Human islet transplantation: a preliminary report. Transplant Proc, 1977, 9(1): 233-236.
- 50. Baldwin XL, Williams BM, Schrope B, et al. What is new with total pancreatectomy and autologous islet cell transplantation? Review of current progress in the field. J Clin Med, 2021, 10(10): 2123. doi: 10.3390/jcm10102123.
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