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World J Gastroenterol. Nov 14, 2013; 19(42): 7292-7301
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7292
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7292
Pharmacological pain management in chronic pancreatitis
Søren S Olesen, Jacob Juel, Asbjørn M Drewes, Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark
Carina Graversen, Mech-Sense, Department of Radiology, Aalborg University Hospital, 9000 Aalborg, Denmark
Carina Graversen, Department of Neurorehabilitation Engineering, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, D-37077 Göttingen, Germany
Yuri Kolesnikov, Pain Service, Department of Oncology, East Tallinn Central Hospital, 19086 Tallinn, Estonia
Oliver HG Wilder-Smith, Pain and Nociception Neuroscience Research Group, Department of Anaesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, 6525 Nijmegen, The Netherlands
Oliver HG Wilder-Smith, Asbjørn M Drewes, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark
Author contributions: All authors contributed to this review.
Supported by Karen Elise Jensen`s Foundation and Danish Council for Strategic research, The Danish Agency for Science, Technology and Innovation
Correspondence to: Søren S Olesen, MD, PhD, Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark. sso@mech-sense.com
Telephone: +45-9-9326243 Fax: +45-9-9326507
Received: June 8, 2013
Revised: August 5, 2013
Accepted: August 20, 2013
Published online: November 14, 2013
Revised: August 5, 2013
Accepted: August 20, 2013
Published online: November 14, 2013
Core Tip
Core tip: Pharmacological pain management in chronic pancreatitis is complicated and requires a multidisciplinary approach. Identification of risk factors associated with disease progression and evaluation of extra pancreatic causes of pain and complications is essential in all patients. Analgesics are typically titrated according to the World Health Organization ladder principle, but in some situations a top-down approach may be useful to control pain and avoid sensitization of central pain pathways. Adjuvant analgesics and combinations of drugs should be considered at an early stage. Non-encapsulated enzyme therapy, somastotatin-analogues and antioxidants can be considered as supplements to conventional analgesics in special situations.