Chronic pancreatitis: management of pain.

Pain is the main symptom in chronic pancreatitis (CP). Since frequency, duration, severity and cause of pain in CP differ in patients, pain management becomes a challenge for physicians, which often requires a multidisciplinary approach. The first step is the exclusion of any anatomic abnormality (e.g. pseudocysts, compression of adjacent visceral structures) that could be the origin of pain. Medical measures such as abstinence from alcohol, use of analgesics, and suppression of exocrine pancreatic secretion may be useful, mainly in patients with early- to moderate-stage CP. Endoscopic interventions may alleviate pain in some selected cases. When nonoperative measures fail to alleviate pain and pain interferes significantly with the quality of life, surgery should be considered. Celiac plexus block and epidural anesthesia are procedures to be used only in selected cases.