Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis

Søren S Olesen; Anna E Phillips; Mahya Faghih; Louise Kuhlmann; Emily Steinkohl; Jens B Frøkjær; Benjamin L Bick; Mitchell L Ramsey; Phil A Hart; Pramod K Garg; Vikesh K Singh; Dhiraj Yadav; Asbjørn M Drewes; Pancreatic Quantitative Sensory Testing (P-QST) Consortium

doi:10.1136/gutjnl-2021-325855

Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis

Søren S Olesen^*, Anna E Phillips, Mahya Faghih, Louise Kuhlmann, Emily Steinkohl, Jens B Frøkjær, Benjamin L Bick, Mitchell L Ramsey, Phil A Hart, Pramod K Garg, Vikesh K Singh, Dhiraj Yadav, Asbjørn M Drewes, Pancreatic Quantitative Sensory Testing (P-QST) Consortium

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

11 Citations (Scopus)

Abstract

OBJECTIVE: Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).

DESIGN: We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.

RESULTS: Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.

CONCLUSION: Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.

TRIAL REGISTRATION NUMBER: The study was registered with ClinicalTrials.gov (NCT03434392).

Original language	English
Journal	Gut
Volume	71
Issue number	12
Pages (from-to)	2518-2525
Number of pages	8
ISSN	0017-5749
DOIs	https://doi.org/10.1136/gutjnl-2021-325855
Publication status	Published - Dec 2022

Bibliographical note

Keywords

abdominal pain
chronic pancreatitis
endoscopy
pancreas
pancreatic surgery

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10.1136/gutjnl-2021-325855

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Olesen, S. S., Phillips, A. E., Faghih, M., Kuhlmann, L., Steinkohl, E., Frøkjær, J. B., Bick, B. L., Ramsey, M. L., Hart, P. A., Garg, P. K., Singh, V. K., Yadav, D., Drewes, A. M., & Pancreatic Quantitative Sensory Testing (P-QST) Consortium (2022). Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis. Gut, 71(12), 2518-2525. Advance online publication. https://doi.org/10.1136/gutjnl-2021-325855

@article{ff0371b16d7047adb68997af19ea5b4a,

title = "Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis",

abstract = "OBJECTIVE: Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).DESIGN: We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.RESULTS: Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.CONCLUSION: Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.TRIAL REGISTRATION NUMBER: The study was registered with ClinicalTrials.gov (NCT03434392).",

keywords = "abdominal pain, chronic pancreatitis, endoscopy, pancreas, pancreatic surgery",

author = "Olesen, {S{\o}ren S} and Phillips, {Anna E} and Mahya Faghih and Louise Kuhlmann and Emily Steinkohl and Fr{\o}kj{\ae}r, {Jens B} and Bick, {Benjamin L} and Ramsey, {Mitchell L} and Hart, {Phil A} and Garg, {Pramod K} and Singh, {Vikesh K} and Dhiraj Yadav and Drewes, {Asbj{\o}rn M} and {Pancreatic Quantitative Sensory Testing (P-QST) Consortium}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = dec,

doi = "10.1136/gutjnl-2021-325855",

language = "English",

volume = "71",

pages = "2518--2525",

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Olesen, SS, Phillips, AE, Faghih, M, Kuhlmann, L, Steinkohl, E, Frøkjær, JB, Bick, BL, Ramsey, ML, Hart, PA, Garg, PK, Singh, VK, Yadav, D, Drewes, AM & Pancreatic Quantitative Sensory Testing (P-QST) Consortium 2022, 'Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis', Gut, vol. 71, no. 12, pp. 2518-2525. https://doi.org/10.1136/gutjnl-2021-325855

TY - JOUR

T1 - Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis

AU - Olesen, Søren S

AU - Phillips, Anna E

AU - Faghih, Mahya

AU - Kuhlmann, Louise

AU - Steinkohl, Emily

AU - Frøkjær, Jens B

AU - Bick, Benjamin L

AU - Ramsey, Mitchell L

AU - Hart, Phil A

AU - Garg, Pramod K

AU - Singh, Vikesh K

AU - Yadav, Dhiraj

AU - Drewes, Asbjørn M

AU - Pancreatic Quantitative Sensory Testing (P-QST) Consortium

PY - 2022/12

Y1 - 2022/12

N2 - OBJECTIVE: Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).DESIGN: We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.RESULTS: Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.CONCLUSION: Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.TRIAL REGISTRATION NUMBER: The study was registered with ClinicalTrials.gov (NCT03434392).

AB - OBJECTIVE: Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).DESIGN: We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.RESULTS: Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.CONCLUSION: Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.TRIAL REGISTRATION NUMBER: The study was registered with ClinicalTrials.gov (NCT03434392).

KW - abdominal pain

KW - chronic pancreatitis

KW - endoscopy

KW - pancreas

KW - pancreatic surgery

UR - http://www.scopus.com/inward/record.url?scp=85136253833&partnerID=8YFLogxK

U2 - 10.1136/gutjnl-2021-325855

DO - 10.1136/gutjnl-2021-325855

M3 - Journal article

C2 - 34675068

SN - 0017-5749

VL - 71

SP - 2518

EP - 2525

JO - Gut

JF - Gut

IS - 12

ER -

Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis

Abstract

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