Clinical Trials Study
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World J Gastroenterol. Jul 21, 2014; 20(27): 9154-9161
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9154
Pain sensation in pancreatic diseases is not uniform: The different facets of pancreatic pain
Jan G D’Haese, Mark Hartel, Ihsan Ekin Demir, Ulf Hinz, Frank Bergmann, Markus W Büchler, Helmut Friess, Güralp O Ceyhan
Jan G D’Haese, Mark Hartel, Ihsan Ekin Demir, Helmut Friess, Güralp O Ceyhan, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675 Munich, Germany
Ulf Hinz, Unit for Documentation and Statistics, Department of General Surgery, University of Heidelberg, 69117 Heidelberg, Germany
Frank Bergmann, Institute of Pathology, University of Heidelberg, 69117 Heidelberg, Germany
Markus W Büchler, Department of General Surgery, University of Heidelberg, 69117 Heidelberg, Germany
Author contributions: D’Haese JG and Hartel M contributed equally to this manuscript; Ceyhan GO, and Friess H designed and supervised the study; D’Haese JG and Hartel M performed the data collection and analysis; Demir IE and Hinz U performed and verified the statistical analyses; Friess H and Büchler MW provided the clinical data for correlation analyses; Bergmann F made the histopathological verification of the diagnosis and cancer classification; D’Haese JG, Hartel M, Demir IE, and Ceyhan GO wrote the manuscript; all authors read and approved the final version of the manuscript.
Correspondence to: Güralp O Ceyhan, MD, Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, D-81675 Munich, Germany. gueralp.ceyhan@tum.de
Telephone: +49-89-41405091 Fax: +49-89-41404870
Received: November 12, 2013
Revised: January 13, 2014
Accepted: April 2, 2014
Published online: July 21, 2014
Abstract

AIM: To systematically characterize specific pain patterns in the most frequent pancreatic diseases.

METHODS: Pain in patients with chronic pancreatitis (n = 314), pancreatic cancer (n = 469), and other pancreatic tumors (n = 249) including mucinous (n = 20) and serous cystadenoma (n = 31), invasive (n = 37) and non-invasive intraductal papillary mucinous neoplasia (IPMN; n = 48), low stage (n = 18) and high stage neuroendocrine neoplasia (n = 44), and ampullary cancer (n = 51) was registered and correlated with clinicopathological data. Survival times were estimated by the Kaplan-Meier method. Patients alive at the follow-up time were censored. Survival curves were compared statistically using the log-rank test.

RESULTS: Forty-nine point one percent of pancreatic cancer patients revealed no pain, whereas in chronic pancreatitis only 18.3% were pain free. In contrary, moderate/severe pain was registered in 15.1% in pancreatic cancer patients that was increased in chronic pancreatitis with up to 34.2%. Serous cystadenoma was asymptomatic in most cases (58.1%), whereas 78.9% of all mucinous cystadenoma patients suffered pain. In neuroendocrine neoplasia pain was not a key clinical symptom since 64% of low stage neuroendocrine neoplasia and 59% of high stage neuroendocrine neoplasia patients were pain free. Cancer localization in the pancreatic body and patients with malignant pancreatic neoplasms were associated with more severe pain. Tumor grading and stage did not show any impact on pain. Only in pancreatic cancer, pain was directly associated with impaired survival.

CONCLUSION: Pancreatic pain depicts different patterns of abdominal pain sensation according to the respective pancreatic disorder and does not allow a unification of the term pancreatic pain.

Keywords: Abdominal pain, Pancreatic neoplasm, Chronic pancreatitis, Intraductal papillary mucinous neoplasia, Pancreatic cancer

Core tip: Abdominal pain is a major clinical feature in chronic pancreatitis and pancreatic cancer. Little is known about pain sensations in other, less frequent pancreatic tumors. This study is to our knowledge the first to systematically record pain patterns in all pancreatic tumors. Additionally, these were correlated with clinicopathological data. Pain patterns in pancreatic diseases turned out to be very diverse and mainly dependent on tumor type, anatomic localization and dignity. In pancreatic cancer pain was significantly associated with impaired survival.