Chronic pancreatitis and pain -: an interdisciplinary challenge

Pain therapy is central part of the interdisciplinary treatment of chronic pancreatitis. Basal treatment included a graduated pain scheme of pain treatment considering light as well as heavy pain. Pain plasters containing buprenorphine or fentanyl have been increasingly used. In case of obstruction of the pancreatic duct and/or the distal bile duct, interventional endoscopic procedures should be applied. Pain is triggered among other things by a pressure increase in the duct system. Decompression of the pancreatic duct by stone extraction - if necessary combined with extracorporeal shockwave lithotripsy - and plastic stent application are suitable measures to achieve a longer lasting absence of pain in 60% of the cases. Strictures of the pancreatic duct can also be treated by stent application or dilatation albeit with a lower success rate. A positive response on decompression is a positive criterion to select patients who will profit from a sanitation by suitable draining or combined resecting/draining surgical procedures. Bigger prospective studies comparing the various methods are not available so far. In case of a long lasting course of chronic pancreatitis, the risk of developing a pancreatic carcinoma is high. This should be kept in mind during differential diagnosis as well.