The Pathogenesis of Chronic Pancreatitis
Chronic abdominal pain remains a major clinical challenge in chronic pancreatitis (CP) and is present in up to 90% of the patients. It is associated with a poor life quality, an increased health resource utilization and is the primary cause of hospitalization Lieb et al. (Aliment Pharmacol Ther 29:706–19, 2009). The etiologies of pain in CP are increasingly better understood and likely involve multiple mechanisms. The focus of this chapter is to provide an overview of the mechanisms involved in chronic pancreatic pain. First, the traditional view of pain in CP is discussed where pain is thought to arise due to mechanical problems such as obstruction of the pancreatic gland. Although this theory is widely accepted and forms the theoretical background for invasive treatments of pain it is largely undocumented and has been challenged by recent research where no uniform associations between morphological changes and pain exist. The next section provides an overview of a novel neurobiological understanding of pain in CP, which is shifting the focus of pain from mechanical problems towards changes in peripheral and central pain processing. This has substantial consequences for treatment and may result in a paradigm shift of pain management of CP in a foreseeable future. Finally, we briefly discuss extra-pancreatic causes of pain in associated with CP, which are important to diagnose, as they are often easy to treat.
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