Dr. Milan Mehta

Pain due to Chronic Pancreatitis

Chronic pancreatitis is a progressive inﬂammatory reaction of the pancreas that causes irreversible morphological changes of the parenchyma (ﬁbrosis, loss of acini and islets of Langerhans, and pancreatic stone formation) as well as the ductuspancreaticus (stenosis).

Pain in chronic pancreatitis requires a multidisciplinary approach, in which lifestyle changes are essential.

If the patient suffers from pseudocysts, obstruction of the ductuscholedochus or the duodenum, this should be treated ﬁrst.

Treatment with pancreatic enzyme supplementation, octreotide, and antioxidants can be considered.

Significant pain associated with chronic pancreatitis can seriously reduce a patient’s quality of life. It is important to treat chronic pancreatitis as soon as it is diagnosed because repeated episodes of inflammation can cause irreversible damage, and pain relief becomes much less effective. Pain relief can be achieved with medication, often using the World Health Organization’s 3-step ladder approach to pain relief:

Many patients with chronic pancreatitis receive antioxidants with their pain medicine, which has been shown to help with pain relief. There are other options for pain relief, such as a celiac plexus block, which may provide another option for significant pain relief. The celiac plexus block is achieved via injection and prevents the nerves that travel from the pancreas from reporting pain signals back to the brain.

If there is a narrowing of the pancreatic duct, placement of a plastic tube called a stent into the duct can be helpful in alleviating pain symptoms (done by gastroentrologist)

Radiofrequency treatment of the splanchnic nerve can be considered in patients with pain that is refractory to conservative treatment.

INTERVENTIONAL PAIN MANAGEMENT
Splanchnic Nerve Block
The speciﬁc anatomy in which the nervisplanchnici are located in a narrow compartment allows a targeted denervation. RF thermolesioning, in which denervation only takes place at the tip of the electrode, seems more suitable for this indication.

RF treatment of the splanchnic nerve as a treatment of upper abdominal pain was conﬁrmed by means of a diagnostic block with a local anesthetic.

Signiﬁcant pain reduction was observed, accompanied by a clear decrease in the need for opiates and acute hospitaliza- tion. Moreover, the parameters of the quality of life improves as well.

Spinal Cord Stimulation The use of SCS to treat visceral pain was initially described in case reports.Pain relief exceeded 50% in most of the patients and long-term opioid use decreased by more than two-thirds.