Pain Management in Chronic Pancreatitis

Pain is the dominating symptom in chronic pancreatitis (CP) and leads to frequent hospitalizations. Severe pain has a major influence on quality of life and interferes with daily activities, and it needs to be addressed when caring for patients with CP. Pain pathophysiology in CP is multifactorial, and pain treatment needs to be multidisciplinary and tailored to the individual patient to achieve the best results. On that note, pain treatment should start with a thorough pain assessment and standardized follow-up.

Pain management can include several modalities, including noninvasive treatments such as lifestyle changes and neuromodulation, surgical and endoscopic treatments, and pharmacologic treatment. When choosing a treatment strategy, it is important to remember that pain in CP is a combination of nociceptive and neuropathic/neuroplastic pain. This chapter outlines pain assessment and treatment recommendations with a flowchart to guide noninvasive treatments.