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ABSTRACT
Introduction
Pain is the most common symptom in chronic pancreatitis and treatment remains a challenge. Management of visceral pain, in general, is only sparsely documented, and treatment in the clinic is typically based on empirical knowledge from somatic pain conditions. This may be problematic, as many aspects of the neurobiology differ significantly from somatic pain, and organs such as the gut and liver play a major role in tolerability to analgesics. On the other hand, clinical awareness and new methods for quantitative assessment of pain mechanisms, will likely increase our understanding of the visceral pain system and guide more individualized pain management.
Areas covered
This review includes an overview of known pain mechanisms in chronic pancreatitis and how to characterize them using quantitative sensory testing. The aim is to provide a mechanism-oriented approach to analgesic treatment, including treatment of psychological factors affecting pain perception and consideration of side effects in the management plan.
Expert opinion
A mechanism-based examination and profiling of pain in chronic pancreatitis will enable investigators to provide a well-substantiated approach to effective management. This mechanism-based, individualized regime will pave the road to better pain relief and spare the patient from unnecessary trial-and-error approaches and unwanted side effects.
Article highlights
Although pain is the most frequent symptom in chronic pancreatitis, pain management is an ongoing challenge.
In chronic pain conditions, several pain mechanisms can be affected, and pain can therefore affect each individual differently.
Although still in a developmental phase, somatic quantitative sensory testing can be used to diagnose visceral pain mechanisms.
Many analgesics are targeting specific pain mechanisms.
By individualizing pain treatment, pain control is achieved faster, and the patient need not test several analgesics, each accompanied by different side effects.
There are several psychological factors that influence pain perception, and these should be treated alongside the pain to achieve sufficient pain control.
This box summarizes key points contained in the article.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.