Update on pain management in acute pancreatitis

Purpose of reviewThis review discusses the analgesic options available from randomized controlled trials and recent systematic reviews. The evidence from other settings is considered and the evidence specific to acute pancreatitis emphasized. This highlights the options that are best supported by evidence but also the options that warrant further clinical trials.Recent findingsNonsteroidal anti-inflammatory drugs and paracetamol can provide adequate pain relief in patients with acute pancreatitis when compared with opioids. Epidural analgesia provides optimum pain relief in the first 24 h of onset of acute pancreatitis in addition to potential improvement in pancreatic perfusion. Several experimental analgesics and acupuncture have potential as opioid sparing strategies. Opioids are needed for patients with severe pain, to which adjuvant and experimental analgesics might be added.SummaryAmong the many options for pain management, the following principles should apply:1.tailor treatment to the individual patient (one size will not fit all);2.assess both pain intensity and pancreatitis severity when selecting analgesics;3.a step-down approach might be required achieve prompt pain relief (especially in patients with severe acute pancreatitis);4.use opioid sparing strategies whenever possible (especially in patients with mild acute pancreatitis); and5.patients should be enrolled in much needed clinical trials where possible.