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. 2023 Jul;21(7):1781-1791.e4.
doi: 10.1016/j.cgh.2022.09.026. Epub 2022 Oct 1.

Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Dhiraj Yadav  1 , Robert L Askew  2 , Tonya Palermo  3 , Liang Li  4 , Dana K Andersen  5 , Minxing Chen  4 , William E Fisher  6 , Evan L Fogel  7 , Christopher E Forsmark  8 , Phil A Hart  9 , Mohamed O Othman  10 , Stephen J Pandol  11 , Walter G Park  12 , Mark D Topazian  13 , Stephen K Van Den Eeden  14 , Santhi Swaroop Vege  13 , Yunlong Yang  4 , Jose Serrano  9 , Darwin L Conwell  9 ; Consortium for the Study of Chronic Pancreatitis, Diabetes; Pancreatic Cancer (CPDPC)
Affiliations

Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Dhiraj Yadav et al. Clin Gastroenterol Hepatol. 2023 Jul.

Abstract

Background and aims: Pain is a cardinal symptom of chronic pancreatitis (CP). Using Patient-Reported Outcomes Measurement Information System (PROMIS) measures, we characterized physical and mental health and symptom profiles of a well-defined cohort of individuals with CP and compared them with control subjects. Among patients with CP, we also examined associations between pain (intensity, temporal nature) and PROMIS symptom profiles and the prevalence of clinically significant psychological comorbidities.

Methods: We analyzed baseline data in 488 CP patients and 254 control subjects enrolled in PROCEED (Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies), an ongoing longitudinal cohort study. Participants completed the PROMIS-Global Health, which captures global physical and mental health, and the PROMIS-29 profile, which captures 7 symptom domains. Self-reported pain was categorized by severity (none, mild-moderate, severe) and temporal nature (none, intermittent, constant). Demographic and clinical data were obtained from the PROCEED database.

Results: Pain was significantly associated with impairments in physical and mental health. Compared with participants with no pain, CP participants with severe pain (but not mild-moderate pain) had more decrements in each PROMIS domain in multivariable models (effect sizes, 2.54-7.03) and had a higher prevalence of clinically significant depression, anxiety, sleep disturbance, and physical disability (odds ratios, 2.11-4.74). Similar results were noted for constant pain (but not intermittent pain) for PROMIS domains (effect sizes, 4.08-10.37) and clinically significant depression, anxiety, sleep disturbance and physical disability (odds ratios, 2.80-5.38).

Conclusions: Severe and constant pain are major drivers for poor psychological and physical health in CP. Systematic evaluation and management of psychiatric comorbidities and sleep disturbance should be incorporated into routine management of patients with CP. (ClinicalTrials.gov, Number: NCT03099850).

Keywords: Anxiety; Depression; PROMIS; Pancreas; Pancreatitis; Sleep disturbance.

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Conflict of interest statement

Conflict of Interest: The authors declare no relevant conflicts.

Figures

Figure 1.
Figure 1.
Radar chart showing PROMIS 29 symptom profile* for comparisons between participants with CP and controls (panel A), CP categorized by pain severity (panel B), and CP categorized by pain temporality (panel C)* The center of the radar plot represents a score of 30 on all seven domains of the PROMIS-29, and the outer edges of the plot represent a score of 70. Separate lines represent distinct subgroups. The further a line is from the center, the higher the mean score is on that domain. *Comparisons for each PROMIS domain (chronic pancreatitis vs. controls; pain categories in chronic pancreatitis [severe vs. no pain, and constant vs. no pain]) were significant (p<0.001)
Figure 2.
Figure 2.
Prevalence of moderate-severe symptoms of depression (panel A), anxiety (panel B), sleep disturbance (panel C), and low physical function (panel D) in participants with chronic pancreatitis
See this image and copyright information in PMC

Comment in

  • Comments on Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health.
    Yi JH, Liu Y, Hu LH. Yi JH, et al. Clin Gastroenterol Hepatol. 2023 Sep;21(10):2702-2703. doi: 10.1016/j.cgh.2022.12.015. Epub 2022 Dec 23. Clin Gastroenterol Hepatol. 2023. PMID: 36566816 No abstract available.
  • Reply.
    Yadav D, Askew RL, Palermo T, Li L, Conwell DL; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC). Yadav D, et al. Clin Gastroenterol Hepatol. 2023 Sep;21(10):2703-2704. doi: 10.1016/j.cgh.2023.01.027. Epub 2023 Feb 3. Clin Gastroenterol Hepatol. 2023. PMID: 36739933 No abstract available.

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