Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India, 400004.
Curr Gastroenterol Rep. 2023 Oct;25(10):260-266. doi: 10.1007/s11894-023-00898-1. Epub 2023 Sep 15.
The data on recent advances in managing chronic pancreatitis (CP) pain is limited. This review highlights the role of endotherapy and the advances in the overall management of pain in CP.
Of late, pancreatic biodegradable stents have been used in endotherapy with appreciable success. These include slow, medium, and fast degrading stents, which optimize the overall management of CP and could prevent the need for multiple procedures. Endoscopic ultrasound-guided celiac plexus block is reserved in selected patients to treat debilitating pain. Total pancreatectomy with islet autotransplantation in small duct disease has shown promising results. The indications for treating pain in CP with endoscopy and surgery need to be better defined. The complexity of pain control due to the incomplete understanding of pathomorphology makes the management of CP challenging. The current treatment methods are still evolving. Therapy aims to reduce pain, optimize recovery, maintain quality of life, and meet postoperative needs. Initial management includes lifestyle modification, nutrition optimization, risk factor reduction with abstinence from alcohol, cessation of tobacco and smoking. Supportive medical management involves the judicial use of analgesics, neuromodulators, antioxidants, pancreatic enzyme replacement for insufficiency, and diabetes management. Patients with intractable pain are ideal for therapeutic intervention. Being less invasive with an acceptable complication rate makes endotherapy the preferred first-line treatment. If found to be cost-effective, biodegradable stents can reduce the overall cost. Unfortunately, if patients remain symptomatic, surgery is preferred in case of failure or recurrence. For optimal results, appropriate patient selection is vital to maximizing outcomes.
慢性胰腺炎（CP）疼痛管理方面的最新进展数据有限。本综述重点介绍了内镜治疗的作用以及 CP 疼痛整体管理方面的进展。
最近，生物可降解的胰腺支架已被用于内镜治疗，并取得了相当大的成功。这些支架包括慢、中、快降解支架，它们优化了 CP 的整体管理，并且可以防止需要多次手术。内镜超声引导腹腔神经丛阻滞保留用于治疗致残性疼痛的特定患者。在小胰管疾病中进行全胰切除术伴胰岛自体移植已显示出有希望的结果。需要更好地定义内镜和手术治疗 CP 疼痛的适应证。由于对病理形态学的不完全了解导致疼痛控制的复杂性，使得 CP 的管理具有挑战性。目前的治疗方法仍在不断发展。治疗旨在减轻疼痛、优化恢复、维持生活质量并满足术后需求。初始管理包括生活方式改变、营养优化、减少酒精摄入、戒烟和停止吸烟以降低风险因素。支持性的医疗管理包括合理使用镇痛药、神经调节剂、抗氧化剂、胰腺酶替代治疗不足以及糖尿病管理。对于难治性疼痛患者，治疗干预是理想的选择。内镜治疗具有微创性和可接受的并发症发生率，使其成为首选的一线治疗方法。如果发现具有成本效益，生物可降解支架可以降低总体成本。不幸的是，如果患者仍然有症状，手术是首选方法，以防治疗失败或复发。为了获得最佳效果，适当的患者选择对于最大限度地提高治疗效果至关重要。
