Pain management in chronic pancreatitis, by @DarwinConwell
@AmCollegeGastro #ACG2021 #pancreas #GITwitter
@AmCollegeGastro #ACG2021 #pancreas #GITwitter
PAIN is the most common symptom of chronic pancreatitis
30% placebo response in chronic pancreatitis
The pathophysiology of chronic pancreatitis is complex, but is predominantly a neuropathic pain syndrome.
Pancreas-directed therapies may not be treating the cause of the pain!
Pancreas-directed therapies may not be treating the cause of the pain!
Extrapancreatic sources of pain contribute to pain in the most severe cases of chronic pancreatitis. 78% may have non-visceral pain.
Pain processing is altered in chronic pancreatitis
Pancreatic enzymes don't do much for treating the pain of chronic pancreatitis.
‼️Pregabalin has good data for chronic pancreatitis.
(Insurance companies may require failure of gabapentin first...)
(Insurance companies may require failure of gabapentin first...)
Antox can be ordered from 🇬🇧
Tramadol is effective for CP pain, especially early (before on long-term opioids)
Enteral nutrition can improve pain
Surgery is superior to endoscopy for chronic pancreatitis. Can use endoscopic therapy as a bridge.
Frey procedure can achieve excellent results.
Frey procedure can achieve excellent results.
Smoking cessation is 🔑; avoid opioids unless absolutely necessary
There IS hope for chronic pancreatitis!
The future of CP is mechanism-based approach. Target pain management to pathophysiology
Need to understand the contributors of pain and take into careful account psychosocial contributors
Sleep for example, is important for healthy pain processing
Sleep for example, is important for healthy pain processing
The 🧠 in chronic pancreatitis is differently wired.
PROCEED study
Internet based cognitive behavioral therapy for chronic pancreatitis
Mechanism-based approach
Take home points from @DarwinConwell
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