Antonín Vavrečka, Michaela Swekla
Pain can accompany acute and chronic pancreatitis and tumours of the pancreas. It is one of the main symptoms of
chronic pancreatitis. Pain is multifactorial, and its cause has not been fully clarified until now. Several mechanisms can
cause it: obstruction of the pancreatic ducts (strictures, stones) with subsequent ductal and parenchymal hypertension,
lesions of pancreatic nerves (pancreatic neuropathy) and their nociceptive changes with central sensitivity followed by
hyperalgesia and allodynia, hormonal changes (rise of cholecystokinin with a following stimulation of pancreas). Pancreatic
pain localised in the epigastrium, and the periumbilical area can radiate to the left or the back underneath shoulder
blade. It is usually constant but can be intermittent. Pain is variable, during disease it can subside or end. Given the
multifactorial character of pancreatic pain, treatment is complicated and requires a multidisciplinary approach. Abstinence
from alcohol and smoking is necessary. Food intake should be divided into multiple smaller daily portions. Analgesics
are usually required to control pain. Non-opiates are preferred initially. If they are ineffective, weaker opiates
are used, followed by strong opiates, if pain persists. They can lead to several complications (e.g. tolerance, bowel dysfunction).
Pancreatic enzymes have their role in the treatment of pancreatic pain as well. However they are effective
only in some patients. Antioxidants have not been proven effective. If medical treatment fails, endoscopic treatment
(removal of stones and strictures-dilation, stent placement) or ultimately surgical procedures (resection or drainage or
total pancreatectomy) can be considered.