Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Pancreatology. 2017 Sep-Oct;17(5):720-731. doi: 10.1016/j.pan.2017.07.006. Epub 2017 Jul 13.
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories. For pain relief, current guidelines recommend a simple stepwise escalation of analgesic drugs with increasing potency until pain relief is obtained. Abstinence from alcohol and smoking should be strongly advised. Pancreatic enzyme therapy and antioxidants may be helpful as initial treatment. Endoscopic treatment can be used in patients with evidence of ductal obstruction and may be combined with extracorporeal shock wave lithothripsy. The best candidates are those with distal obstruction of the main pancreatic duct and in early stage of disease. Behavioral interventions should be part of the multidisciplinary approach to chronic pain management particularly when psychological impact is experienced. Surgery should be considered early and after a maximum of five endoscopic interventions. The type of surgery depends on morphological changes of the pancreas. Long-term effects are variable, but high success rates have been reported in open studies and when compared with endoscopic treatment. Finally, neurolytical interventions and neuromodulation can be considered in difficult patients.
腹痛是慢性胰腺炎（CP）的首要并发症。疼痛可能与复发性或慢性炎症、局部并发症或神经性机制有关，相应地神经系统也会发生变化。CP 患者的疼痛强度和发作频率都已被证明会降低生活质量。疼痛评估遵循其他类型慢性疼痛的指南，其中考虑到症状表现的多维性质。定量感觉测试可用于表征疼痛，但目前仅在高级实验室的研究环境中使用。为了缓解疼痛，目前的指南建议逐步升级镇痛药物，增加其效力，直到疼痛缓解为止。应强烈建议患者戒酒和戒烟。胰酶治疗和抗氧化剂可能作为初始治疗有帮助。对于有胆管阻塞证据的患者，可以进行内镜治疗，并且可以与体外冲击波碎石术联合使用。最佳人选是那些主胰管远端阻塞和疾病早期的患者。行为干预应该是慢性疼痛管理多学科方法的一部分，特别是当经历心理影响时。应尽早考虑手术，并且最多进行五次内镜干预后。手术类型取决于胰腺的形态变化。长期效果各不相同，但在开放性研究和与内镜治疗比较时，报告的成功率很高。最后，可以考虑对困难患者进行神经松解和神经调节。
