Parasar Kunal, Mohan Shantam, John Aaron G, Anand Utpal
Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND.
Gastroenterology, All India Institute of Medical Sciences, Patna, IND.
Cureus. 2021 Feb 18;13(2):e13423. doi: 10.7759/cureus.13423.
Background Prolonged lockdown in our country provided us with a unique opportunity to study the interplay of psychosocial impact on pain in surgically treated patients of chronic pancreatitis. Methods Forty-one patients who underwent surgery for chronic pancreatitis in the last 24 months were followed up, of which 27 were enrolled. The data were collected telephonically. Pain was assessed using the numeric pain rating (NPR) scale and depression using Patient Health Questionnaire (PHQ) 9. In patients having recent onset pain during the lockdown, oral tramadol 50 mg and amitryptiline 25 mg were prescribed and reassessed after two weeks. Results Of the 25 pain-free patients in February (pre-lockdown), 14 developed pain of varying intensity during the lockdown and were prescribed medications. Twelve out of 14 patients had very good resolution of pain after two weeks of medication. Conclusions Operated patients with chronic pancreatitis who developed new-onset depression and pain responded well to low-dose anti-depressants in addition to analgesics. This study gives indirect, objective evidence that covert depression leading to pain in chronic pancreatitis is often downplayed and interpreted as poor results of surgery.
背景 我国长期的封锁为我们提供了一个独特的机会，来研究心理社会因素对慢性胰腺炎手术治疗患者疼痛的相互作用。方法 对过去24个月内接受慢性胰腺炎手术的41例患者进行随访，其中27例被纳入研究。通过电话收集数据。使用数字疼痛评分（NPR）量表评估疼痛，使用患者健康问卷（PHQ）9评估抑郁情况。对于在封锁期间近期出现疼痛的患者，开具口服曲马多50毫克和阿米替林25毫克的处方，并在两周后重新评估。结果 在2月（封锁前）无痛的25例患者中，14例在封锁期间出现了不同程度的疼痛并接受了药物治疗。14例患者中有12例在用药两周后疼痛得到了很好的缓解。结论 患有慢性胰腺炎且出现新发抑郁和疼痛的手术患者，除了使用镇痛药外，对低剂量抗抑郁药反应良好。这项研究提供了间接的客观证据，表明慢性胰腺炎中导致疼痛的隐性抑郁常常被忽视，并被解释为手术效果不佳。
