Pharmacological management of pain in chronic pancreatitis

Introduction: Chronic pancreatitis is a condition that is rising in incidence in the Western World. It is predominated by severe intractable abdominal pain that presents a significant impact on patients' quality of life and physical functioning. The pain is persistent in many patients, requiring admission to hospital for the majority at some stage in their illness. There is no current NICE or SIGN guideline with associated grading for the pharmacological management of this symptom. This paper aims to investigate and summarise the current pharmacological therapies for pain control in an attempt to formulate the levels of evidence supporting their use. Methods: The online digital archives PubMed, Science Direct, Medscape and the Cochrane Library were searched for the keywords pain and chronic pancreatitis. Hand searches of relevant journals and citations were used to complete the investigation of current literature on the topic. Relevant articles and studies were critically analysed in a standard format with relation to study type, population, number, end point and outcomes. Publications not relevant to the management of pain in chronic pancreatitis were excluded. Results: Medical therapies, including oral analgesics and enzyme preparations, were included in the analysis of current modalities for treating pain in chronic pancreatitis. Conclusions: A summary of the evidence base for different pharmacological treatments in the context of chronic pancreatitis has shown that large number trials evaluating their efficacy in managing pain are lacking and offer scope for future research on this topic. The use of 'alternative' treatments such as antioxidant preparations and enzyme antagonists has shown promise. With regard to opioids, tramadol is as effective as morphine with less neuropsychiatric and gastrointestinal side effects. Oxycodone may derive more benefit than morphine due to an additional K-agonist effect.