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©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 14, 2013; 19(38): 6319-6328
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6319
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6319
Pain in chronic pancreatitis: Managing beyond the pancreatic duct
Rupjyoti Talukdar, D Nageshwar Reddy, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad 500082, India
Rupjyoti Talukdar, Asian Healthcare Foundation, Somajiguda, Hyderabad 500082, India
Author contributions: Talukdar R conceptualized the manuscript, critically reviewed relevant literature and drafted the paper; Reddy DN critically reviewed the manuscript and provided intellectual inputs.
Correspondence to: Rupjyoti Talukdar, MD, Clinical Pancreatologist, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India. rup_talukdar@yahoo.com
Telephone: +91-402-3378888 Fax: +91-402-3324255
Received: July 6, 2013
Revised: July 31, 2013
Accepted: August 5, 2013
Published online: October 14, 2013
Revised: July 31, 2013
Accepted: August 5, 2013
Published online: October 14, 2013
Core Tip
Core tip: Pain in chronic pancreatitis (CP) has multiple but simultaneously occurring mechanisms. Recent data have shown expression of nociceptors and neurotrophic factors in different neural locations. The expression of these and other neural chemokines (fractalkine) have positive correlation with pain. Pain also results from global sensitization. Among the therapeutic modalities, beneficial effects have been demonstrated with methionine containing antioxidant micronutrients supplements and pregabalin. Of the pancreatic enzymes, only non-enteric coated preparations might benefit a subgroup of patients. The threshold for performing celiac neurolysis should be high in view of variable response across clinical trials.