A clinical approach to treating pain in chronic pancreatitis

Objective.To discuss the clinical approach to treating pain in chronic pancreatitis (CP). Methods: Review of the literature. Results: CP is an inflammatory condition characterized by irreversible and progressive destruction of the pancreatic parenchyma and pancreatic ducts, which leads to debilitating symptoms of severe abdominal pain. The etiology of pain in pancreatitis is multifactorial. Currently, as none of the therapies can counteract the inflammatory process of CP, management has included analgesics for pain management and enzyme replacement for exocrine insufficiency, with endoscopic and surgical techniques reserved for treating the complications of CP, such as ductal anatomic abnormalities. Diagnostic techniques are now underway to improve early detection of CP for both optimizing treatments and for prevention of complications, which include malabsorption, ductal obstruction, and pancreatic cancer. Noninvasive methods for pain management such as nonenteric-coated pancreatic enzymes, prokinetics in cases of concomitant gastric dysmotility due to CP, pregabalin, antioxidants, nerve blocks, and endoscopic interventions have yielded better results than were found in the past decade. Conclusion: As the pathophysiology of CP is fully delineated, the resultant pancreatic exocrine and endocrine Insufficiencies associated with the disease can be better treated.