Singh Vikesh K, Drewes Asbjørn M
Pancreatitis Center, Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mech-Sense, Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej, 9000, Aalborg, Denmark.
Dig Dis Sci. 2017 Jul;62(7):1721-1728. doi: 10.1007/s10620-017-4605-z. Epub 2017 May 18.
The medical management of pain in chronic pancreatitis continues to pose significant challenges for clinicians caring for these patients. There are increasing data, suggesting that pain in chronic pancreatitis is largely due to peripheral and central sensitization that evolves, over time, as a result of nociceptive afferent associated with chronic inflammation and fibrosis of the pancreas. In many instances, patients rapidly progress to requiring opioid analgesics for the adequate treatment of pain despite the unequivocal risks associated with the long-term use of these drugs. Centrally acting drugs, such as gabapentinoids, appear to be effective means of treating pain due to their inhibition of neurotransmitters involved in central sensitization, but side effects limit their use. The present review explores the evidence for various non-pharmacologic and pharmacologic treatments for pain in chronic pancreatitis.
慢性胰腺炎疼痛的药物治疗，对于照料这些患者的临床医生而言，仍然是重大挑战。越来越多的数据表明，慢性胰腺炎的疼痛很大程度上是由于外周和中枢敏化，随着时间推移，这种敏化是由与胰腺慢性炎症和纤维化相关的伤害性传入神经引起的。在许多情况下，尽管长期使用这些药物存在明确风险，但患者仍迅速进展到需要使用阿片类镇痛药来充分治疗疼痛。作用于中枢的药物，如加巴喷丁类药物，似乎是治疗疼痛的有效手段，因为它们能抑制参与中枢敏化的神经递质，但副作用限制了它们的使用。本综述探讨了慢性胰腺炎疼痛各种非药物和药物治疗的证据。
