JLE

Hépato-Gastro & Oncologie Digestive

MENU

Chronic pancreatitis: new concepts in pain management strategies (part 2) Volume 21, issue 10, Décembre 2014

Authors
Hôpital Beaujon,
100, boulevard du général Leclerc,
92110 Clichy Cedex,
France
* Tirés à part

Pain in chronic pancreatitis (CP) remains difficult to treat mainly due to a lack of understanding about the underlying nociceptive process. Hence, treatments are frequently based on anatomical grounds although morphological changes are not correlated with pain intensity.

Nevertheless, it is well established, that cause of pain in chronic pancreatitis involves multiples mechanisms. Traditional theories only focused on the role of the local anatomy in the pancreas but studies have provided multiple evidences than pain processing is abnormal in patient with CP and resembles to that seen in neuropathic pain disorder. Moreover, others etiology of nociception may contribute to abdominal pain. Hence, this pain of CP is probably the result of a complex interplay between several mechanisms witch could explain the partial success or failure of single modality treatment approaches.

In addition, the mechanisms underlying pain are highly variable in patients. Therefore, there is not a single approach that is effective for all individuals.

Besides, many reports have questioned the validity of the so called “burn-out” hypothesis including the group that first introduced it. Pain is probably not a “self-limiting” disease in which pain will ultimately resolve spontaneously due to progressive parenchyma destruction of the pancreas as postulated by the “burn-out” hypothesis. Hence, patient should probably be treated more aggressively and early.

All these novel insights require a paradigm shift in pain management. In particular, treatments should take into account the underlying mechanism of pain and a more personalized pain medicine is required. In order to give the appropriate treatment which suits a specific patient, development of tools to identify the underlying pain mechanism is highly desirable.