Pain patterns in chronic pancreatitis and chronic primary pain |
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| Affiliation: | 1. The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand;2. The Auckland Regional Pain Service (TARPS), Auckland District Health Board (ADHB), Auckland, New Zealand;3. The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand;4. Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand;5. Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark;6. Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark;7. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;8. Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand;9. Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand;1. Department of Medicine II, LMU University Hospital, Munich, Germany;2. Department of Medicine IV, LMU University Hospital, Munich, Germany;3. Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU University Hospital, Munich, Germany;4. Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland;5. Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland;6. Institute of Pathology, Faculty of Medicine, LMU, Munich, Germany;7. Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland;8. Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland;1. Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden;2. Department of Surgery and Perioperative Sciences, Surgery, Umeå University Hospital, Umeå, Sweden;3. Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy;4. Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy;5. Division of Surgery, Uppsala University Hospital, Uppsala, Sweden;6. Digestive and Liver Disease Unit, Sant''Andrea Hospital, Sapienza University of Rome, Rome, Italy;7. Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, USA;8. Department for Upper Abdominal Diseases, Karolinska University Hospital and Department of Medicine Huddinge, Karolinska Institute, Sweden;1. Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA;2. Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA;3. Parkview Cancer Institute, Fort Wayne, Indiana, USA;4. Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA;5. Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA;6. Health Administration, Rutgers University, New Brunswick, NJ, USA;7. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA;1. Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA;2. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA;1. Gastroenterology Clinic, Adnan Menderes Bulvar?, Vatan Cad, 34093, Fatih, ?stanbul, Turkey;2. Internal Medicine Clinic, Medicana International Hospital, Beylikdüzü Cd. No:3, 34520, Beylikdüzü, ?stanbul, Turkey |
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| Abstract: | BackgroundAbdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator.AimsThis cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes.MethodsPatients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics.ResultsCompared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent.ConclusionsWithin CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms. |
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| Keywords: | Biopsychosocial model Chronic pain Chronic pancreatitis Pain assessment Pain phenotypes |
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