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16. 慢性胰腺炎中的疼痛。

16. Pain in chronic pancreatitis.

作者信息

van Zeggeren Laura, Boelens Nabbi Raha, Kallewaard Jan Willem, Steegers Monique, Cohen Steven P, Kapural Leonardo, van Santvoort Hjalmar, Wolff André

机构信息

Department of Anesthesiology and Pain Medicine, Rijnstate Hospital, Arnhem, The Netherlands.

Department of Anesthesiology, UMCG Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

出版信息

Pain Pract. 2025 Apr;25(4):e70030. doi: 10.1111/papr.70030.


DOI:10.1111/papr.70030
PMID:40189721
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11973027/
Abstract

INTRODUCTION: Chronic pancreatitis is defined as a disease of the pancreas in which recurrent inflammatory episodes result in replacement of the pancreatic parenchyma by fibrous connective tissue in individuals with genetic, environmental, and other risk factors. Pain is one of the most important symptoms of chronic pancreatitis and, in many cases, has chronic visceral nociceptive, nociplastic, and even neuropathic components, with evidence of both central and peripheral sensitization, neuroplasticity, and neurogenic inflammation. METHODS: The literature on the diagnosis and treatment of pain in chronic pancreatitis was reviewed and summarized. RESULTS: Treatment of abdominal pain in chronic pancreatitis is guided by pancreatic morphology on imaging, although the correlation between pain symptoms and pathoanatomical changes is not always straightforward. Patients with pancreatic duct obstruction are initially offered endoscopic or surgical therapies, while non-obstructive disease is mostly managed medically. Lifestyle changes and psychological support are of particular importance for all chronic pancreatitis patients. Analgesic options range from non-opioid medications to opioids and adjuvant agents. Interventional pain management may consist of radiofrequency treatment of the splanchnic nerves and spinal cord stimulation. To date, there are no randomized trials supporting their efficacy in the treatment of chronic pancreatitis pain, and the recommendation to consider these treatment options is justified by evidence from observational studies. Possible opioid-sparing effects of interventional pain treatments are important to consider because opioid use and dependency are common in chronic pancreatitis patients and associated with worse outcomes. Celiac plexus block is not generally recommended for chronic pancreatitis due to the limited quality of evidence, overall short duration of effect, and invasiveness of the procedure. Central sensitization can impact the effectiveness of invasive treatments. CONCLUSIONS: Managing pain in chronic pancreatitis is a complex task that requires a multidimensional and individualized approach. Due to the lack of randomized trials, treatment decisions are often guided by expert opinion. Integrating pharmacological and non-pharmacological interventions and collaborating with a multidisciplinary team are key components of effective chronic pancreatitis pain management.

摘要

引言:慢性胰腺炎被定义为胰腺的一种疾病,在有遗传、环境及其他风险因素的个体中,反复的炎症发作导致胰腺实质被纤维结缔组织替代。疼痛是慢性胰腺炎最重要的症状之一,在许多情况下,具有慢性内脏伤害性感受、神经病理性疼痛,甚至神经病变成分,有中枢和外周敏化、神经可塑性和神经源性炎症的证据。 方法:对慢性胰腺炎疼痛的诊断和治疗相关文献进行了综述和总结。 结果:慢性胰腺炎腹痛的治疗以影像学上的胰腺形态为指导,尽管疼痛症状与病理解剖变化之间的相关性并不总是直接的。胰管梗阻患者最初接受内镜或手术治疗,而非梗阻性疾病大多采用药物治疗。生活方式改变和心理支持对所有慢性胰腺炎患者尤为重要。镇痛选择范围从非阿片类药物到阿片类药物和辅助药物。介入性疼痛管理可能包括内脏神经的射频治疗和脊髓刺激。迄今为止,尚无随机试验支持它们在治疗慢性胰腺炎疼痛方面的疗效,考虑这些治疗选择的建议是基于观察性研究的证据。介入性疼痛治疗可能具有的阿片类药物节省效应很重要,因为阿片类药物的使用和依赖在慢性胰腺炎患者中很常见,且与更差的预后相关。由于证据质量有限、总体效果持续时间短以及该操作具有侵入性,一般不推荐对慢性胰腺炎患者进行腹腔神经丛阻滞。中枢敏化会影响侵入性治疗的效果。 结论:慢性胰腺炎疼痛的管理是一项复杂的任务,需要多维度和个体化的方法。由于缺乏随机试验,治疗决策往往以专家意见为指导。整合药物和非药物干预措施并与多学科团队合作是有效管理慢性胰腺炎疼痛的关键组成部分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/9e499094309e/PAPR-25-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/6c686f61aa02/PAPR-25-0-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/8df80821a980/PAPR-25-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/09f1c0ea2b0b/PAPR-25-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/bc62d63cb735/PAPR-25-0-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/9e499094309e/PAPR-25-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/6c686f61aa02/PAPR-25-0-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/8df80821a980/PAPR-25-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/09f1c0ea2b0b/PAPR-25-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/bc62d63cb735/PAPR-25-0-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3043/11973027/9e499094309e/PAPR-25-0-g001.jpg

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引用本文的文献

[1]
Navigating chronic pancreatitis pain: a pathophysiological and therapeutic overview.

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本文引用的文献

[1]
Risk factors associated with pain and pain relief in patients with chronic pancreatitis.

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[2]
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Clin Transl Gastroenterol. 2024-9-1

[3]
Epidemiology and Characteristics of Chronic Pancreatitis-Do the East and West Meet?

Gastro Hep Adv. 2022-8-3

[4]
Ten-kHz Spinal Cord Stimulation vs Radiofrequency Ablation of Splanchnic Nerves: A Single-Site Retrospective Comparison of 12-Month Outcomes.

Neuromodulation. 2024-12

[5]
Neural circuits regulating visceral pain.

Commun Biol. 2024-4-13

[6]
Spinal Cord Stimulation for Intractable Visceral Pain Originating from the Pelvic and Abdominal Region: A Narrative Review on a Possible New Indication for Patients with Therapy-Resistant Pain.

J Pain Res. 2024-2-19

[7]
Advances in the Management of Pain in Chronic Pancreatitis.

Curr Gastroenterol Rep. 2023-10

[8]
Fluoroscopy-Guided Splanchnic Nerve Block for Cancer-Associated Pain.

Cureus. 2022-10-31

[9]
The Role of the Human Microbiome in the Pathogenesis of Pain.

Int J Mol Sci. 2022-10-31

[10]
Characterizing mechanism-based pain phenotypes in patients with chronic pancreatitis: a cross-sectional analysis of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies.

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