Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes

Table 1 Common causes of chronic pancreatitis

Toxic metabolic

Xenobiotics

Alcohol

Cigarette smoking[12]

Genetic mutations

CFTR mutation (Cystic Fibrosis Transmembrane Conductance Regulator) PRSS1 mutation (Protease, Serine 1)

SPINK1 mutation (Serine Peptidase Inhibitor, Kazal type 1)

CTRC (chymotrypsin C)

Chronic Obstruction of main pancreatic duct

Cancer

Post-duct destruction in severe attack

Recurrent acute pancreatitis

Autoimmune

Idiopathic

Early or late onset

Tropical

Table 2 Pattern of pancreatic pain

Episodic mild to moderate pain

Constant mild to moderate pain

Typically pain free between episodes of severe pain

Constant mild pain with episodes of severe pain

Constant pain

Table 3 Mechanisms of pain in chronic pancreatitis

Increased intraductal pressure

Ductal obstruction from strictures/stones

Increased intrapancreatic pressure (compartment-like syndrome)

Fibrosis causing lack of distensibility

Neuropathic

Entrapment of nerves

Damage of nerves by enzymes

Increased nerve tissue

Pancreatic ischemia

Worsened during increased enzyme secretion