Controlling Pancreatitis Pain

In patients with pancreatitis, treatments for the nervous system, rather than the pancreas itself, might better reduce pain, according to a study in the August issue of Clinical Gastroenterology and Hepatology.

Chronic pancreatitis is painful—surgery or endoscopy to reduce pressure in the parenchyma or in the pancreatic duct does not always relieve patients’ pain. Søren Schou Olesen et al. studied pain control in 25 patients with chronic pancreatitis and 15 healthy volunteers. Following an initial painful stimuli (holding a hand in ice-cold water), people normally have a much higher tolerance for subsequent painful stimuli (pressure to the quadriceps muscle)—this is known as descending pain modulation. Olesen et al. found that this process was defective in patients with pancreatitis; they were much more sensitive to the second painful stimulus than the healthy volunteers. The patients with chronic pancreatitis were also more sensitive to electrical and heat stimulation of the rectosigmoid colon.

The authors propose that recurrent pancreatic pain attacks might alter the way the central nervous system processes information about pain, making patients with pancreatitis more sensitive to stimuli. Similar effects have been observed in patients with irritable bowel syndrome and fibromyalgia.

The protocol used for the experiment. The cold pressor test is used as conditioning stimulus to induce descending pain inhibition (DNIC) in healthy volunteers and patients with chronic pancreatitis. Somatic pressure stimulations of the quadriceps muscle are used to quantify the effect of DNIC. To investigate central pain processing, multimodal (electrical, heat, and mechanical) stimulation of the rectosigmoid is performed. Simultaneous recordings of evoked brain potentials are obtained during the electrical stimulations of the rectosigmoid. Median nerve stimulations with simultaneous recordings of evoked brain potentials are performed to evaluate the presence of neuropathy in peripheral or central nervous pathways.

In an accompanying editorial, Peter Czakanski and Timothy Ness recommend that clinicians change their approach to patients with chronic pancreatitis; in addition to repairing damage to the pancreas, they should also address descending pain modulation from supraspinal structures and central nervous system sensitization using analgesics, anti-depressants, or anti-convulsant ion-channel inhibitors. Further experiments are required to determine whether impaired pain modulation is a cause or secondary effect of the pain associated with pancreatic inflammation.

More Information on Pancreatitis:

What do you think? Use the “Leave a Comment” link below to post your thoughts.

Read the article online:
Olesen SS, Brock C, Krarup AL, et al. Descending inhibitory pain modulation is impaired in patients with chronic pancreatitis. Clin Gastroenterol and Hepatol 2010;8:724–730.

Read the accompanying editorial:
Czakanski P and Ness TJ. Impaired diffuse noxious inhibitory controls: an additional mechanism of pain in chronic pancreatitis? Clin Gastroenterol and Hepatol 2010;8:647–648.

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About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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2 Responses to Controlling Pancreatitis Pain

  1. Peggy henry says:

    I have been dealing with chronic pancreatist for over 6 years and i need to know what to bout pain.my blood work comes back normal sometimes.

  2. Trevor Gibb says:

    Hi I am the owner of Pancreatitis Diet net. I would like to see if you would be willing to give us a link to our site, in exchange we would be willing to provide an article for your site. Our site is a great resource for pancreatitis diet and we provide a free E-book to each visitor you send.

    Link:
    http://www.pancreatitisdiet.net/

    Our readers love our ebook and it is a wonderful resource to share with your readers. Here is some of the feedback we have received from our readers:

    Dear Michael,

    Mostly I want to say a great big THANK YOU!!! for writing the book, making it readily available and sharing with others what you’ve learned.

    I was diagnosed with pancreatitis less than 2 weeks ago. I had a bad attack starting on the 21st. I finally was pain free yesterday.

    Thanks,
    Trevor Gibb

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