Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

Michelle A Anderson¹, Venkata Akshintala², Kathryn M Albers³, Stephen T Amann⁴, Inna Belfer⁵, Randall Brand², Suresh Chari⁶, Greg Cote⁷, Brian M Davis³, Luca Frulloni⁸, Andres Gelrud⁹, Nalini Guda¹⁰, Abhinav Humar¹¹, Rodger A Liddle¹², Adam Slivka², Rachelle Stopczynski Gupta², Eva Szigethy¹³, Jyothsna Talluri², Wahid Wassef¹⁴, C Mel Wilcox¹⁵, John Windsor¹⁶, Dhiraj Yadav², David C Whitcomb¹⁷

Affiliations

¹ Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
² Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
³ Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ North Mississippi Medical Center, Tupelo, MS, USA.
⁵ Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
⁶ Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
⁸ Department of Medicine, University of Verona, Verona, Italy.
⁹ Department of Medicine, University of Chicago, Chicago, IL, USA.
¹⁰ Department of Gastroenterology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA.
¹¹ Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
¹² Department of Medicine, Duke University, Durham, NC, USA.
¹³ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Department of Medicine, University of Massachusetts, Worcester, MA, USA.
¹⁵ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Department of Surgery, University of Auckland, Auckland, New Zealand.
¹⁷ Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology & Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu.

PMID: 26620965
PMCID: PMC4761301
DOI: 10.1016/j.pan.2015.10.015

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

Michelle A Anderson et al. Pancreatology. 2016 Jan-Feb.

. 2016 Jan-Feb;16(1):83-94.

doi: 10.1016/j.pan.2015.10.015. Epub 2015 Nov 11.

Authors

Affiliations

¹ Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
² Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
³ Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ North Mississippi Medical Center, Tupelo, MS, USA.
⁵ Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
⁶ Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
⁸ Department of Medicine, University of Verona, Verona, Italy.
⁹ Department of Medicine, University of Chicago, Chicago, IL, USA.
¹⁰ Department of Gastroenterology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA.
¹¹ Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
¹² Department of Medicine, Duke University, Durham, NC, USA.
¹³ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Department of Medicine, University of Massachusetts, Worcester, MA, USA.
¹⁵ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Department of Surgery, University of Auckland, Auckland, New Zealand.
¹⁷ Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology & Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu.

PMID: 26620965
PMCID: PMC4761301
DOI: 10.1016/j.pan.2015.10.015

Abstract

Description: Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking.

Methods: Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement.

Results: Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking.

Management: There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies.

Conclusions: Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.

Keywords: Chronic pain; Chronic pancreatitis; Inflammation; Pancreatic surgery; Quality of life; Therapeutic endoscopy.

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Conflict of interest statement

Disclosure Statement

The authors have no relevant conflict of interest related to this material.

References

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Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

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Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

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