TY - JOUR
T1 - Painful chronic pancreatitis - New approaches for evaluation and management
AU - Yadav, Dhiraj
AU - Palermo, Tonya M.
AU - Phillips, Anna E.
AU - Bellin, Melena D.
AU - Conwell, Darwin L.
N1 - Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Purpose of reviewManagement of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis.Recent findingsChronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy.SummarySeveral lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
AB - Purpose of reviewManagement of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis.Recent findingsChronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy.SummarySeveral lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
KW - TPIAT
KW - chronic pancreatitis
KW - cognitive behavioral therapy
KW - pain
KW - psychosocial factors
KW - quantitative sensory testing
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U2 - 10.1097/mog.0000000000000769
DO - 10.1097/mog.0000000000000769
M3 - Review article
C2 - 34172622
AN - SCOPUS:85114198376
SN - 0267-1379
VL - 37
SP - 504
EP - 511
JO - Current opinion in gastroenterology
JF - Current opinion in gastroenterology
IS - 5
ER -