November 12, 2014
Notes: Takenaka, Mamoru
J Hepatobiliary Pancreat Sci. 2014 Apr;21(4):275-80. doi: 10.1002/jhbp.24. Epub 2013 Aug 30.
Author Address: Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Reference Type: Journal Article
Record Number: 4859Author: Talukdar, R. and Reddy, D. N.
Title: Pain in chronic pancreatitis: managing beyond the pancreatic duct
Journal: World J Gastroenterol
Date: Oct 14
Short Title: Pain in chronic pancreatitis: managing beyond the pancreatic duct
Alternate Journal: World journal of gastroenterology : WJG
ISSN: 2219-2840 (Electronic)
Accession Number: 24151350
Keywords: Abdominal Pain/diagnosis/*etiology/physiopathology/therapy
Abstract: Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute.