Pharmacological pain management in chronic pancreatitis

Søren S Olesen, Jacob Juel, Carina Graversen, Yuri Kolesnikov, Oliver Wilder-Smith, Asbjørn M Drewes

Research output: Contribution to journalJournal articleResearchpeer-review

30 Citations (Scopus)

Abstract

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.
Original languageEnglish
JournalWorld Journal of Gastroenterology
Volume19
Issue number42
Pages (from-to)7292-301
Number of pages10
ISSN1007-9327
DOIs
Publication statusPublished - 14 Nov 2013

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