November 12, 2014
Notes: Bian, Yun
World J Gastroenterol. 2013 Nov 7;19(41):7177-82. doi: 10.3748/wjg.v19.i41.7177.
Author Address: Yun Bian, Li Wang, Chao Chen, Jian-Ping Lu, Jia-Bao Fan, Shi-Yue Chen, Bing-Hui Zhao, Department of Radiology, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China.
Reference Type: Journal Article
Record Number: 4620Author: Bouwense, S. A., Ahmed Ali, U., ten Broek, R. P., Issa, Y., van Eijck, C. H., Wilder-Smith, O. H. and van Goor, H.
Title: Altered central pain processing after pancreatic surgery for chronic pancreatitis
Journal: Br J Surg
Short Title: Altered central pain processing after pancreatic surgery for chronic pancreatitis
Alternate Journal: The British journal of surgery
ISSN: 1365-2168 (Electronic)
Accession Number: 24227367
Keywords: Abdominal Pain/*physiopathology
Central Nervous System/*physiology
Central Nervous System Sensitization/physiology
Cold Temperature/diagnostic use
Abstract: BACKGROUND: Chronic abdominal pain is common in chronic pancreatitis (CP) and may involve altered central pain processing. This study evaluated the relationship between pain processing and pain outcome after pancreatic duct decompression and/or pancreatic resection in patients with CP. METHODS: Patients with CP underwent quantitative sensory testing. Pain processing was measured via electrical pain detection (ePDT) and electrical pain tolerance (ePTT) thresholds in dermatomes C5 and L4. Inhibitory descending pain control mechanisms were assessed using the conditioned pain modulation (CPM) paradigm. Healthy controls and patients with CP were compared, and patients with CP and a poor pain outcome (visual analogue scale (VAS) score greater than 30) were compared with those with a good pain outcome (VAS score 30 or less). RESULTS: Forty-eight patients with CP had lower ePDT, ePTT and CPM responses compared with values in 15 healthy controls (P < 0.030). The sum of ePDT values was lower in patients with a poor pain outcome than in those with a good outcome (median 7.1 versus 11.2 mA; P = 0.008). There was a correlation with the VAS score and the sum of ePDT values (rs = -0.45, P = 0.016) and ePTT values (rs = -0.46, P = 0.011), and CPM response (rs = -0.43, P = 0.006) in patients with CP. CONCLUSION: After pain-relieving pancreatic surgery, patients with CP exhibit altered central pain processing compared with that in healthy controls. Poor pain outcomes are associated with more central sensitization and more pronociceptive descending pain modulation, and this should be considered when managing persistent pain after pain-relieving surgery for CP.