Why Does Chronic Pancreatitis Cause Excruciating Pain & How Is It Treated?
About Chronic Pancreatitis:
Chronic pancreatitis causes severe abdominal pain mostly localized over upper abdomen. Pain associated with chronic pancreatitis is continuous, referred to back and lasts for hours to days.
Chronic pancreatitis pain gets worse after eating and drinking. Pain may respond to pain medications during episode of pancreatitis. You should not take any pain medication when there is no pain between episodes of severe pain associated with chronic pancreatitis. Recent advanced surgical treatment may alleviate chronic pancreatitis pain. Pain and suffering of chronic pancreatitis causes severe depression1.
Why Does Chronic Pancreatitis Cause Excruciating Pain?
Pancreas and surrounding tissues are necrotic because of lipase and amylase acting on soft tissue. Chronic pancreatitis pain is caused by irritation of nerve fibers surrounding these necrotic tissue. Chronic pancreatitis causes biophysiological changes in pancreatic nociceptors or pain receptors resulting in higher excitability associated with down regulation of potassium current at receptors2. These changes cause low threshold and increase transmission of pain impulses.
Does Necrotic Pancreas Function Normal?
Chronic persistent pancreatitis causes extensive necrosis and scarring of pancreas. Scarred pancreas is unable to secrete enzymes. Lack of enzymes causes improper digestion of fat and protein as well as lack of insulin causes diabetes.
Is Chronic Pancreatitis a Common Disease?
No, Chronic pancreatitis is not a common illness. Chronic pancreatitis is observed in 0.003 to 0.009% of population.3
What is the Most Common Cause of Chronic Pancreatitis?
70% of the chronic pancreatitis cases are alcohol induced3. Other causes of chronic pancreatitis2 are repeat episodes of acute pancreatitis, blockage of the pancreatic duct or the common bile duct secondary to stricture due to edema, fibrosis or cancer, complications of cystic fibrosis, hyperparathyroidism, tropical (nutritional), hypercalcemia and calcific stones.
What Are The Risk Factors For Chronic Pancreatitis?
Risk factors which may induce or exaggerate symptoms of chronic pancreatitis are chronic smoking, regular alcohol intake and genetic susceptibility4. Other risk factors are ductal obstruction and autoimmune disease4 if acute pancreatitis is not appropriately treated. Ductal obstruction and autoimmune disease should be diagnosed and treated as soon as possible.4
Watch 3D Video of Chronic Pancreatitis, Its Causes and Symptoms:
What Are The Other Symptoms Of Chronic Pancreatitis In Addition To Pain?
Chronic pancreatitis causes weight loss, diarrhea, nausea, vomiting and pale fatty stool.
What Are The Different Lab Tests Done To Diagnose Chronic Pancreatitis?
Tests to diagnose acute pancreatitis include:
- Blood examination:
- Specific Tests: Elevated serum amylase, serum lipase, serum trypsinogen and serum IgG4.
- Nonspecific Tests: Elevated serum bilirubin, and alkaline phosphatase.
- Autoimmune disease: Elevated ESR, IgG4, rheumatoid factors , ANA and antismooth muscle antibody.
- Stool examination - fecal fat test.
- CAT scan - of abdomen and pancreas.
- Magnetic Resonance Cholangiopancreatography (MRCP).
- Ultrasound - Pancreas and surrounding tissue.
- ERCP - Endoscopic Retrograde Cholangiopancreatography.
- Endoscopic Ultrasound (EUS).
How Does One Differentiate Acute Pancreatitis and Chronic Pancreatitis?
Acute pancreatitis is the first incident of inflammation of pancreas. Chronic pancreatitis is a lingering condition associated with multiple episodes of pancreatitis. In acute pancreatitis amylase and lipase serum levels are always elevated but it may not be elevated in chronic pancreatitis. Secretin stimulation test is a diagnostic gold standard and level is increased in chronic pancreatitis. Fecal elastase measurement is diagnostic test for chronic pancreatitis.
How is Chronic Pancreatitis Treated?
Treatment for Chronic Pancreatitis includes:
- Medications - Analgesics, I.V. insulin
- I.V. Fluid and I.V. nutrition
- Oral feeding:
- Initial: Fasting and nasogastric suction.
- Later: Oral feeding when possible: low fat diet and frequent small meal.
- Supplemental Medications for Chronic Pancreatitis- Vitamins, calcium, pancreatic enzyme.
- Interventional Rx to Treat Chronic Pancreatitis - Celiac plexus nerve block.
- Surgery to Treat Chronic Pancreatitis- Surgery is recommended for bile duct blockage, in severe cases part or all of the pancreas may be removed5.
Watch 3D Video of Celiac Plexus Block Procedure:
Which is the Recent Most Effective Treatment for Chronic Pancreatitis?
Most effective treatment for chronic pancreatitis includes Antioxidant, endoscopic surgery and management of endocrine and exocrine insufficiency may reduce the symptoms.6
What is the Treatment to Prevent Frequent Attack of Chronic Pancreatitis?
One of the ways to avoid frequent attack of chronic pancreatitis is to avoid alcohol completely. Other recommendations to prevent chronic pancreatitis are biliary decompression, calcium supplements, ductal decompression (endoscopic or surgical), low-fat diet, nerve blocks, opioid analgesics, pancreatic enzyme supplements, pseudocyst decompression (endoscopic or surgical), resection using distal pancreatectomy5, resection using pancreaticoduodenectomy (Kausch-Whipple or pylorus-preserving), and vitamin/antioxidant supplement. In few cases of chronic pancreatitis, complete pain relief is achieved with Beger procedure.7
If All Treatment Fails And Chronic Pancreatitis Pain Is Intractable, What Would Be The Treatment Of Choice?
Oral opioid is gold standard for chronic pancreatitis pain relief during first 3 to 6 months. After continuous oral opioid intake you may be dependent on opioid and you may develop tolerance and resistance to opioid. Instead you should consider intrathecal pain medications to treat chronic pancreatitis. After trial dose if chronic pancreatitis pain relief is satisfactory then you could consider intrathecal modality of delivering pain medication using programmable pump8.
What are the Complications Involved in Chronic Pancreatitis?
Complication of chronic pancreatitis are ascites, obstruction of the small intestine or bile duct, deep vein thrombosis, blood clot in spleen, pancreatic pseudocyst, diabetes, malabsorption, and vitamin deficiency.