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Pancreatic pain

Schmerz bei Pankreaserkrankungen

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Summary

Pain is a common symptom of many diseases. Recently, the pain has been classified and analyzed exactly. Its particular components/types are described to the maximum of their depths and details. That is why each particular pain present in a specific disease (pancreatopathies included) has to be treated according to the presence of the specific type of pain. In diseases of pancreas, there are nociceptive, neuropathic, and inflammatory components of pain participating, frequently. Especially long-lasting, not well-controlled pain sets off the process of neuromodulation. The recent pioneering applications/administrations of various neuromodulatory therapeutic approaches represent the promising discoveries for the treatment of long-term, severe, drug-resistant pain syndromes, including chronic pancreatitis. In this article, we summarized the characteristics of pain, the therapeutic strategy, and algorithms of analgesic treatment (in general and applied for pancreatopathies), including new therapeutic trends and approaches.

Zusammenfassung

Schmerz ist ein unspezifisches Symptom vieler Erkrankungen. Schmerz kann in seinen Qualitäten und Ursachen näher untersucht und klassifiziert werden. Die spezifischen Schmerzursachen und Schmerzkomponenten können mittlerweile detailliert erfasst werden. Auf Grund dessen muss jede Art von Schmerz bei einer Erkrankung, so auch bei Erkrankungen des Pankreas, spezifisch nach dem jeweiligen Schmerztyp behandelt werden. Bei Pankreaserkrankungen liegen regelmäßig nozizeptive, neuropathische und inflammatorische Schmerzkomponenten vor und spielen zusammen als Schmerzursachen eine Rolle. Langanhaltende und schlecht kontrollierte Schmerzzustände führen zu einer Neuromodulation. Rezente Neuerungen bei der Applikation und im Einsatz von verschiedenen neuromodulatorischen Schmerzmedikamenten stellen neue Therapieansätze dar, die die Hoffnung geben, auch bei schweren, lang anhaltenden und mit konventioneller Schmerztherapie schlecht kontrollierbaren Schmerzsyndromen Erfolge zu erzielen, so auch bei der chronischen Pankreatitis. Im vorliegenden Artikel werden die Schmerzkomponenten, die Therapiestrategien sowie die Algorithmen der Schmerztherapie im allgemeinen und speziell für Pankreaserkrankungen dargestellt. Dies beinhaltet auch neue therapeutische Ansätze und Entwicklungen.

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References

  1. Mantyselka P, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain. 2001;89:175–80.

    Article  CAS  PubMed  Google Scholar 

  2. Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165–9.

    Article  PubMed  Google Scholar 

  3. Hasselström J, Liu-Palmgren J, Rasjö-Wrååk G. Prevalence of pain in general practice. Eur J Pain. 2002;6(5):375–85.

    Article  PubMed  Google Scholar 

  4. Abu-Saad Huijer H. Chronic pain: a review. J Med Liban. 2010;58(1):21–7.

    PubMed  Google Scholar 

  5. Bonica JJ, et al. Bonica’s management of pain. Philadelphia: Lippincott Williams & Wilkins; 2001. pp. 3–16.

  6. International Association for the Study of Pain. Pain definitions [cited 10 Sep 2011]. Derived from Bonica JJ. The need of a taxonomy. Pain. 1979;6(3):247–8.

    Google Scholar 

  7. Goroszeniuk T, Khan R. Permanent percutaneous splanchnic nerve neuromodulation for management of pain due to chronic pancreatitis: a case report. Neuromodulation. 2011 May-Jun;14(3):253–7.

    Article  PubMed  Google Scholar 

  8. Felipe F, Kimberly P, Deborah D, Xiaoen W, Robert L, Steven DF, Alvaro PL. Clinical effects and brain metabolic correlates in noninvasive cortical neuromodulation for visceral pain. Eur J Pain. 2011 Jan;15(1):53–60.

  9. Felipe F, Alvaro PL, Steven DF. Pain in chronic pancreatitis: a salutogenic mechanism or a maladaptive brain response? Pancreatology. 2007 Oct.;7(5–6):411–22.

  10. Christianson JA, Bielefeldt K, Altier C, Cenac N, Davis BM, Gebhart GF, Karin WH, Marian K, Alan R, Brad U. Development, plasticity and modulation of visceral afferents. Brain Res Rev. 2009 April;60(1):171–86.

  11. Merskey H, Bogduk N. Classification of Chronic Pain. 2nd ed. Seattle: International Association for the Study of Pain; 1994. p. 3, 4. ISBN 0-931092-05-1.

  12. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 March;152(3 Suppl.):2–15.

  13. Savage SR. Management of acute and chronic pain and cancer pain in the addicted patient. www.adoctorm.com/docs/pain.htm.

  14. International Association for the Study of Pain (2009). “Epidemiology of Cancer Pain”. http://www.iasp-pain.org/AM/Template.cfm?Section=Fact_Sheets1&Template=/CM/ContentDisplay.cfm&ContentID=7395. Accessed 6 June 2012.

  15. Steven D. Freedman, merck manuals online medical library, Last full review/revision Sept 2012. http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html.

  16. Schmidt BL, Hamamoto DT, Simone DA, Wilcox GL. Mechanism of cancer pain. Mol Interv. 2010 June;10(3):164–78.

  17. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009 Sep;10(9):895–926.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 March;152(3 Suppl.):2–15.

  19. Davis MP. Recent advances in the treatment of pain. F1000 Med Rep. 2010;2:63.

    Google Scholar 

  20. Perron V, Schonwetter RS. Assessment and management of pain in palliative care patients. Cancer Control. 2001;8(1):15–24.

    Google Scholar 

  21. Demir IE, Friess H, Ceyhan GO. Nerve-cancer interactions in the stromal biology of pancreatic cancer. Front Physiol. 2012;3:97.

    Google Scholar 

  22. Thapa D, Rastogi V, Ahuja V. Cancer pain management-current status. J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun;27(2):162–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Dite P, Stary K, Novotny I, et al. Incidence of chronic pancreatitis in the Czech Republic. Eur J Gastroenterol Hepatol. 2001,13(6):249–50.

    Google Scholar 

  24. Jup J, Fine D, Johnson CD. The epidemiology and socioeconomic impact of chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2010;24:219–31.

    Google Scholar 

  25. Lankisch PG, Lembcke B. Why is chronic pancreatitis so difficult to detect? Key clinical aspects for an early diagnosis. In: Domínguez-Muñoz JE, Malfertheiner P, editors. Clinical pancreatology: for practising gastroenterologists and surgeons. Oxford: Blackwell Publishing Ltd; 2007. doi:10.1002/9780470987506.ch27.

  26. Fries H, Zhu ZW, diMola FF, et al. Nerve growth factor and its affinity receptor in chronic pancreatitis. Ann Surg. 1999;230:615–24.

    Google Scholar 

  27. Demir IE, Tieftrunk E, Maak M, Friess H, Ceyhan GO. Pain mechanisms in chronic pancreatitis: of a master and his fire. Langenbecks Arch Surg. 2011 Feb;396(2):151–60.

  28. Ceyhan GO, Demir IE, Rauch U, Bergmann F, Müller MW, Büchler MW, Friess H, Schäfer K-H. Pancreatic neuropathy results in “Neural Remodeling” and altered pancreatic innervation in chronic pancreatitis and pancreatic cancer. Am J Gastroenterol. 2009;104:2555–65.

    Google Scholar 

  29. Lenz J, Karasek P, Jarkovsky J, Muckova K, Dite P, Kala Z, Veselska R, Hermanova M. Clinicopathological correlations of nestin expression in surgically resectable pancreatic cancer including an analysis of perineural invasion. J Gastrointestin Liver Dis. 2011 Dec;20(4):389–96.

    PubMed  Google Scholar 

  30. Warshaw AL, Banks PA, Fernandez-Del Castillo C. AGA technical review: treatment of pain in chronic pancreatitis. Gastroenterology. 1998;115:765–6.

    Article  CAS  PubMed  Google Scholar 

  31. Strum WB. Abstinence in alcoholic chronic pancreatitis. Effect on pain and outcome. J Clin Gastroenterol. 1995 Jan;20(1):37–41.

  32. Mossner J, Keim V, Niederau C, et al. Guidelines for therapy of chronic pancreatitis. Consensus Conference of the German Society of Digestive and Metabolic Diseases. Halle 21–23 November 1996. Z Gastroenterol. 1998;36:359–67.

    Google Scholar 

  33. Wilder-Smith CH, Hil L, Osler W, et al. Effect of tramadol and morfine on pair and gastrointestinal function in patients with chronic pancreatitis. Dig Dis Sci. 1999;44:1107–16.

    Article  CAS  Google Scholar 

  34. Olesen S, Bouwense SAW, Wilder-Smith OHG, et al. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized controlled trial. Gastroenterology. 2011;141:536–43.

    Google Scholar 

  35. Drewes AM, Kraup AL, Detrlefsen S, et al. Pain in chronic pancreatitis: the role of neuropathic pain mechanisms. Gut. 2008;57:1616–27.

    Article  CAS  Google Scholar 

  36. Uden S, Bilton D, Nathan I, et al. Antioxidant therapy for reccurent pancreatitis-placebo controlled trial. Aliment Pharmacol Ther. 1990;4:357–71.

    Article  CAS  Google Scholar 

  37. Kirk GR, White JS, McKie I, et al. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. Gastrointest Surg. 2006;10:499–503.

    Article  Google Scholar 

  38. Moesnner J, Secknus R, Meyer J, et al. Treatment of pain with pancreatic extracts in chronic pancreatitis: results of prospective placebo-controlled multicenter trial. Digestion. 1992;53:54–66.

    Article  Google Scholar 

  39. Malesci A, Gaia E, Fioretta A, et al. No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis. Scand J Gastroenterol. 1995;30:392–8.

    Article  CAS  Google Scholar 

  40. Isaksson G, Ihse I. Pain reduction by an oral pancreatic enzyme preparation in chronic pancreatitis. Dig Dis Sci. 1983;28:97–102.

    Article  CAS  Google Scholar 

  41. Halgreen H, Pederson NT, Worning H, et al. Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis. Scand J Gastroent.1986;21:104–8.

    Google Scholar 

  42. Wistead NS, Wilcox CM. Clinical trial sof pancreatic enzyme replacement for painful chronic pancreatitis-a review. Pancreatology. 2009;9:344–50.

    Article  Google Scholar 

  43. Walkowiak J, Witmanowski H, Strzykala K, et al. Inhibition of endogenous pancreatic enzyme secretion by oral pancreatic enzyme treatment. Eur J Clin Invest. 2003;33:65–9.

    Google Scholar 

  44. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis. Endoscopy. 2012;44(8):784–96.

    Article  Google Scholar 

  45. Anderson DK, Frea CF. The evolution of surgical treatment of chronic pancreatitis. Ann Surg. 2010;251:18–32.

    Google Scholar 

  46. Nguyen-Tang T, Dumonceau JM. Endoscopic treatment of chronic pankreatitis, timing, durativ and type of intervention. Best Pract Res Clin Gastroenterol. 2010;24:281–98.

    Google Scholar 

  47. Costamagna, G., Tringali S. Endoscopic treatment of pain in chronic pancreatitis. Clinical Pancreatology for Practising Gastroenterologists and Surgeons. Blackwell; 2005. pp. 280–7.

  48. Dite P, Ruzicka M, Zboril Vl, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003;35:553–8.

    Google Scholar 

  49. Cahen DL, Gouma D, Nio Y, et al. Endoscopic versus surgical drainage of pancreatic duct in chronic pankreatitis. N Engl J Med. 2007;356:676–84.

    Google Scholar 

  50. Kahl S, Zimmermann S, Genz I. Risk factor for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am J Gastroenterol. 2003;98:2448–53.

    Article  Google Scholar 

  51. Gaman A, Kuo B. Neuromodulatory processes of the brain-gut axis. Neuromodulation. 2008 Oct 1;11(4):249–59.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Disclosure

Supported by European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123) and Ministry of Health—grant IGA (NT13434-4/2012).

Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Second Department of Internal Medicine, St. Anne’s University Hospital Brno, Brno, Czech Republic

    Hana Nechutova MD, PhD,  Petr Dite MD, DSc, Bohumil Kianicka MD, PhD &  Miroslav Soucek MD, DSc

  2. International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

    Hana Nechutova MD, PhD &  Miroslav Soucek MD, DSc

  3. First Department of Pathological Anatomy, Medical Faculty of Masaryk University and St. Anne’s University Hospital Brno, Brno, Czech Republic

    Marketa Hermanova MD, PhD

  4. Department of Gastroenterology, Masaryk Memorial Cancer Institute Brno, Brno, Czech Republic

    Ivo Novotny MD, CSc

  5. Medical Faculty Ostrava, Department of Internal Medicine, University Hospital Ostrava and Academic Center of Gastrooncology, Ostrava, Czech Republic

    Petr Dite MD, DSc,  Arnost Martinek CSc & Pavel Klvana MD

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  1. Hana Nechutova MD, PhD
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  2. Petr Dite MD, DSc
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  3. Marketa Hermanova MD, PhD
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  8. Miroslav Soucek MD, DSc
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Correspondence to Hana Nechutova MD, PhD.

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The first and second named authors participated in this article equally; therefore, either of them represents the first author.

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Nechutova, H., Dite, P., Hermanova, M. et al. Pancreatic pain. Wien Med Wochenschr 164, 63–72 (2014). https://doi.org/10.1007/s10354-014-0265-1

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