Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4160
Peer-review started: December 20, 2015
First decision: December 30, 2015
Revised: January 20, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: April 28, 2016
AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump infusion.
METHODS: We recognized 13 patients who underwent intrathecal narcotic pump (ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation (TP + ICT) for chronic pancreatitis (CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians. All patients were evaluated retrospectively using a questionnaire inquiring about their pain control (using a 0-10 pain scale), daily narcotic dose usage, and hospital admission days for pain control before each intervention and during their last follow-up.
RESULTS: All 13 ITNP patients and 30 available TP + ICT patients were evaluated. The mean age was approximately 40 years in both groups. The median duration of pain before intervention was 6 years and 7 years in the ITNP and TP + ICT groups, respectively. The median pain score dropped from 8 to 2.5 (on a scale of 0-10) in both groups on their last follow up. The median daily dose of narcotics also decreased from 393 mg equivalent of morphine sulfate to 8 mg in the ITNP group and from 300 mg to 40 mg in the TP + ICT group. No patient had diabetes mellitus (DM) before either procedure whereas 85% of those who underwent pancreatectomy were insulin dependent on their last evaluation despite ICT.
CONCLUSION: ITNP and TP + ICT are comparable for pain control in patients with CP however with high incidence of DM among those who underwent TP + ICT. Prospective comparative studies and longer follow up are needed to better define treatment outcomes.
Core tip: Total pancreatectomy (TP) is the last resort offered to chronic pancreatitis (CP) patients with intractable pain when other interventions have failed. We wanted to compare pain control and rate of insulin-dependent diabetes in CP patients after TP and autologous islet cell transplantation (ICT) or intrathecal narcotic pump infusion, which is a relatively new and less invasive technique used for chronic analgesia in multiple other clinical settings. We found that pain control was similar between the two interventions after a median follow-up of 3 years yet the rate of insulin-dependent diabetes was still high in the surgical resection group despite the ICT.