Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium.
Pain Pract. 2011 Sep-Oct;11(5):492-505. doi: 10.1111/j.1533-2500.2011.00474.x. Epub 2011 Jun 16.
Chronic pancreatitis is defined as a progressive inflammatory response of the pancreas that has lead to irreversible morphological changes of the parenchyma (fibrosis, loss of acini and islets of Langerhans, and formation of pancreatic stones) as well as of the pancreatic duct (stenosis and pancreatic stones). Pain is one of the most important symptoms of chronic pancreatitis. The pathogenesis of this pain can only partly be explained and it is therefore often difficult to treat this symptom. The management of pain induced by chronic pancreatitis starts with lifestyle changes and analgesics. For the pharmacological management, the three-step ladder of the World Health Organization extended with the use of co-analgesics is followed. Interventional pain management may consist of radiofrequency treatment of the nervi splanchnici, spinal cord stimulation, endoscopic stenting or stone extraction possibly in combination with lithotripsy, and surgery. To date, there are no randomized controlled trials supporting the efficacy of radiofrequency and spinal cord stimulation. The large published series reports justify a recommendation to consider these treatment options. Radiofrequency treatment, being less invasive than spinal cord stimulation, could be tested prior to considering spinal cord stimulation. There are several other treatment possibilities such as endoscopic or surgical treatment, pancreatic enzyme supplementation and administration of octreotide and antioxidants. All may have a role in the management of pain induced by chronic pancreatitis.
慢性胰腺炎被定义为胰腺的一种进行性炎症反应,导致实质(纤维化、腺泡和胰岛的丧失以及胰腺结石的形成)和胰管(狭窄和胰腺结石)的不可逆转的形态学改变。疼痛是慢性胰腺炎的最重要症状之一。这种疼痛的发病机制只能部分解释,因此治疗这种症状往往很困难。慢性胰腺炎引起的疼痛的管理始于生活方式的改变和镇痛药。对于药物治疗,遵循世界卫生组织的三步阶梯,并扩展使用辅助镇痛药。介入性疼痛管理可能包括内脏神经射频治疗、脊髓刺激、内镜支架或结石提取,可能与碎石术联合进行,以及手术。迄今为止,没有随机对照试验支持射频和脊髓刺激的疗效。大量已发表的系列报告证明有理由考虑这些治疗选择。射频治疗比脊髓刺激创伤性更小,可在考虑脊髓刺激之前进行测试。还有其他几种治疗方法,如内镜或手术治疗、胰腺酶补充、奥曲肽和抗氧化剂的应用。所有这些都可能在慢性胰腺炎引起的疼痛管理中发挥作用。
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