Mechanism-based pain management in chronic pancreatitis – is it time for a paradigm shift?

@article{Kuhlmann2019MechanismbasedPM,
  title={Mechanism-based pain management in chronic pancreatitis – is it time for a paradigm shift?},
  author={Louise Kuhlmann and S{\o}ren Schou Olesen and Anne Estrup Olesen and Lars Arendt-Nielsen and Asbj{\o}rn Mohr Drewes},
  journal={Expert Review of Clinical Pharmacology},
  year={2019},
  volume={12},
  pages={249 - 258}
}
ABSTRACT Introduction: Pain is the most common symptom in chronic pancreatitis and treatment remains a challenge. Management of visceral pain, in general, is only sparsely documented, and treatment in the clinic is typically based on empirical knowledge from somatic pain conditions. This may be problematic, as many aspects of the neurobiology differ significantly from somatic pain, and organs such as the gut and liver play a major role in tolerability to analgesics. On the other hand, clinical… 
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19 Citations
Background Citations
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Methods Citations
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19 Citations

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Citation Type

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Treatment of GI pain depends on the precise type of pain and the primary disorder in the patient but can include, for example, pharmacological therapy, cognitive behavioural therapies, invasive surgical procedures, endoscopic procedures and lifestyle alterations.
Patient and Disease Characteristics Associate With Sensory Testing Results in Chronic Pancreatitis
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Sensitivity to pain in CP patients can be characterized by a simple bedside QST and severe clinical pain was associated with reduced CPM function and should be targeted in management.
Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons!
TLDR
While there are many clinical studies that support invasive treatments, there is a paucity of high-quality randomised controlled trials (RCTs) and the current guidelines for endoscopic and surgical treatments for painful CP are inconsistent and tend to reflect a specialty bias.
A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis.
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  • Medicine
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
  • 2019
Pancreatic QST Differentiates Chronic Pancreatitis Patients into Distinct Pain Phenotypes Independent of Psychiatric Comorbidities.
  • M. Faghih, A. Phillips, +5 authors S. S. Olesen
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    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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  • R. Valente, A. Waldthaler, +4 authors J. Löhr
  • Medicine
    Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
  • 2020
TLDR
Despite being traditionally considered as a benign disease, chronic pancreatitis encompasses 10-year mortality rates which are superior to the ones reported for some of the most common cancers.
Pain in Chronic Pancreatitis During the COVID-19 Lockdown: Has It Given Us a New Dimension for Treatment?
TLDR
Operated patients with chronic pancreatitis who developed new-onset depression and pain responded well to low-dose anti-depressants in addition to analgesics, giving indirect, objective evidence that covert depression leading to pain in Chronic pancreatitis is often downplayed and interpreted as poor results of surgery.
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TLDR
This chapter is directed to look at a test for allodynia that can be applied in the clinic, which is validated, does not require sophisticated tools, and is readily accepted by woman.
CGRP and Painful Pathologies Other than Headache.
TLDR
This chapter describes in depth the evidence surrounding CGRP's association with pain in musculoskeletal disorders and also summarises evidence for C GRP being a direct cause of pain in other conditions.
Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE trial): study protocol for a randomized, sham-controlled trial
TLDR
The SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.
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References

SHOWING 1-10 OF 134 REFERENCES
Guidelines for the understanding and management of pain in chronic pancreatitis.
  • A. Drewes, S. Bouwense, +16 authors D. Yadav
  • Medicine
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
  • 2017
Pain in chronic pancreatitis: managing beyond the pancreatic duct.
TLDR
The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain.
Pain in chronic pancreatitis: the role of neuropathic pain mechanisms
TLDR
The mechanism-based understanding of pain in chronic pancreatitis may have important implications for the treatment of pancreatic pain and principles involved in the treatment have many similarities with those recommended in neuropathic pain disorders.
Pathophysiology and management of opioid-induced constipation: European expert consensus statement
TLDR
A pragmatic step-wise approach to opioid-induced constipation is provided, which should simplify management for clinicians and provide a pragmatic management algorithm for day-to-day clinical practice.
Towards a neurobiological understanding of pain in chronic pancreatitis: mechanisms and implications for treatment
TLDR
The neurobiological signature of pain associated with Chronic pancreatitis is associated with abnormal processing of pain at the peripheral and central level of the pain system, which has important clinical implications for treatment and prevention of pain chronification.
Pain management in chronic pancreatitis.
TLDR
The management of symptoms should be of prime concern in most patients with chronic pancreatitis, because pain is the most dominant and the treatment continues to be directed against symptoms and complications.
Management of chronic visceral pain.
TLDR
To optimize treatment and outcomes in chronic visceral pain the authors need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations in central pain processing.
Quantitative Sensory Testing Predicts Pregabalin Efficacy in Painful Chronic Pancreatitis
TLDR
The present study provides first evidence that quantitative sensory testing predicts the analgesic effect of pregabalin in patients with painful chronic pancreatitis and thus comprises a significant step towards personalized pain medicine.
S-Ketamine Modulates Hyperalgesia in Patients With Chronic Pancreatitis Pain
TLDR
S-ketamine infusion is more effective than placebo in increasing PPTs in chronic pancreatitis pain patients immediately after infusion, and this effect did not outlast the infusion.
Experimental human pain models: a review of standardised methods for preclinical testing of analgesics.
TLDR
A brief introduction to the methods used to evoke and assess pain in the skin, muscle and viscera is given and new methods using multimodal stimulation and activation of central pain mechanisms can to a higher degree mimic the clinical situation.
...
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3
4
5
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