Evaluating pain and the quality of life in chronic pancreatitis

Chronic pancreatitis is a painful disease, ranging between uncomplicated courses with recurrent pain but longer pain-free intervals and complicated courses with constant intractable pain or frequent severe attacks of pain. Several factors, including intrapancreatic and extrapancreatic abnormalities, contribute to pain in chronic pancreatitis, and their relative contribution may vary from patient to patient. The natural course of pain is modified by the use of analgesic drugs, by interventional treatment modalities, and by operative procedures. Since standards for the evaluation are lacking, treatment results have been evaluated following very different scales and protocols. Interdisciplinary controlled clinical trials comparing interventional and operative treatment are not yet available. For future studies, it seems necessary to recruit patients following a standardized clinically based staging system, to assess treatment results following standardized measures for pain and quality of life. For these purposes, such a staging system is proposed, and the application of the European Organization for Research and Treatment of Cancer (EORTC) quality of life (QLQ) questionnaire is suggested.