Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group.
DESCRIPTION: Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. METHODS: Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. RESULTS: Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. MANAGEMENT: There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. CONCLUSIONS: Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.
Anderson, MA; Akshintala, V; Albers, KM; Amann, ST; Belfer, I; Brand, R; Chari, S; Cote, G; Davis, BM; Frulloni, L; Gelrud, A; Guda, N; Humar, A; Liddle, RA; Slivka, A; Gupta, RS; Szigethy, E; Talluri, J; Wassef, W; Wilcox, CM; Windsor, J; Yadav, D; Whitcomb, DC
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