Pain and chronic pancreatitis: A complex interplay of multiple mechanisms

Table 1 Pain mechanisms in chronic pancreatitis

Main category	Proposed mechanism/source	Ref.
Plumbing problems	Pancreatic duct hypertension	[14,16,20]
	Pancreatic parenchymal hypertension	[21-23]
	Pancreas morphology	[29,30]
Wiring problems	Peripheral nociception	[35-37]
	Pancreatic neuropathy	[41,42,44]
	Central mechanisms of pain	[50,52,53,56]
Pancreatic and extrapancreatic complications	Pseudocysts	[62,64]
	Duodenal obstruction	[66]
	Bile duct obstruction	[66,67]
	Peptic ulcer	[71,72]
	Splenic vein thrombosis	[75,78]
Adverse effects to treatment	Opioid induced bowel dysfunction	[79]
	Complications to surgery and endoscopic therapy	[12]
	Bacterial overgrowth due to changed bowel motility	[81]
Additional causes	CCK elevation	[82]
	Increased norepinephrine levels	[85]
	Diabetic neuropathy (type 3c diabetes)	[86]
	Mesenteric ischemia1

¹Complications to and/or possible concomitant diseases. CCK: Cholecystokinin.