Binetti M, Tonini V. Pain in chronic pancreatitis: What can we do today? World J Methodol 2024; 14(3): 91169 [PMID: 39310237 DOI: 10.5662/wjm.v14.i3.91169]
Corresponding Author of This Article
Valeria Tonini, MD, Academic Research, Doctor, Researcher, Surgeon, Surgical Oncologist, Department of Medical and Surgical Science, University of Bologna, Via Massarenti 9, Bologna 40138, Italy. valeria.tonini@unibo.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Sep 20, 2024; 14(3): 91169 Published online Sep 20, 2024. doi: 10.5662/wjm.v14.i3.91169
Pain in chronic pancreatitis: What can we do today?
Margherita Binetti, Valeria Tonini
Margherita Binetti, Valeria Tonini, Department of Medical and Surgical Science, University of Bologna, Alma mater Studiorum, Bologna 40138, Italy
Author contributions: Binetti M designed and wrote the article; Tonini V carefully checked both the content and English language.
Conflict-of-interest statement: The authors declare having no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Valeria Tonini, MD, Academic Research, Doctor, Researcher, Surgeon, Surgical Oncologist, Department of Medical and Surgical Science, University of Bologna, Via Massarenti 9, Bologna 40138, Italy. valeria.tonini@unibo.it
Received: December 26, 2023 Peer-review started: December 26, 2023 First decision: January 4, 2024 Revised: January 23, 2024 Accepted: March 11, 2024 Article in press: March 11, 2024 Published online: September 20, 2024 Processing time: 181 Days and 22.9 Hours
Abstract
The aim of this study is to illustrate the complexity of pain management in chronic pancreatitis (CP). In this context, pain represents the most common and debilitating symptom, and it deeply affects patient’s quality of life. Multiple rating scales (unidimensional, bidimensional and multidimensional) have been proposed to quantify CP pain. However, it represents the result of complex mechanisms, involving genetic, neuropathic and neurogenic factors. Considering all these aspects, the treatment should be discussed in a multidisciplinary setting and it should be approached in a stepwise manner. First, a lifestyle change is recommended and nonsteroidal anti-inflammatory drugs represent the gold standard among medical treatments for CP patients. The second step, after medical approach, is endoscopic therapy, especially for complicated CP. In case of failure, tailored surgery represents the third step and decompressive or resection procedures can be chosen. In conclusion, CP pain’s management is challenging considering all these complex aspects and the lack of international protocols.
Core Tip: The aim of this review is to analyse and discuss treatment options in chronic pancreatitis management. Lifestyle change represents the starting point in uncomplicated chronic pancreatitis (CP). Medical treatment should be the first considered in a stepwise approach. The use of nonsteroidal anti-inflammatory drugs is the gold standard, but opioids, antioxidants, neuromodulators have important roles as well. Endoscopic retrograde cholangiopancreatography, extracorporeal shock wave lithotripsy with or without endoscopy, sphincterotomy with stent placement or transgastric drainage can be chosen in complicated CP patients with obstructions or pseudocysts. A decompressive or resection operation can be chosen in surgical treatment. In conclusion, CP pain management is an ongoing challenge because of lack of international consensus on protocols. Nowadays, a tailored step-up treatment discussed in a multidisciplinary setting is considered the best approach.
