Pharmacological pain management in chronic pancreatitis  

作　　者：Sφren S Olesen Jacob Juel Carina Graversen Yuri Kolesnikov Oliver HG Wilder-Smith Asbjφrn M Drewes 

机构地区：[1]MechSense,Department of Gastroenterology and Hepatology,Aalborg University Hospital,9000 Aalborg,Denmark [2]Mech-Sense,Department of Radiology,Aalborg University Hospital,9000 Aalborg,Denmark [3]Department of Neurorehabilitation Engineering,Bernstein Center for Computational Neuroscience,University Medical Center G ttingen,Georg-August University,D-37077 Gttingen,Germany [4]Pain Service,Department of Oncology,East Tallinn Central Hospital,19086 Tallinn,Estonia [5]Pain and Nociception Neuroscience Research Group,Department of Anaesthesiology,Pain and Palliative Care,Radboud University Nijmegen Medical Centre,6525 Nijmegen,The Netherlands [6]Center for Sensory-Motor Interaction,Department of Health Science and Technology,Aalborg University,9000 Aalborg,Denmark

出　　处：《World Journal of Gastroenterology》2013年第42期7292-7301,共10页世界胃肠病学杂志（英文版）

基　　金：Supported by Karen Elise Jensen`s Foundation and Danish Council for Strategic research,The Danish Agency for Science,Technology and Innovation

摘　　要：Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge.Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders.An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established,the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive.Consequently,the management of pain by traditional methods based on nociceptive deafferentation(e.g.,surgery and visceral nerve blockade)becomes difficult and often ineffective.This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis.Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source,which should be reserved for special and carefully selected cases.In this review,we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis.In addition,future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.

关 键 词：Chronic PANCREATITIS PAIN Treatment PHARMACOLOGY ANALGESICS ADJUVANT ANALGESICS 

分 类 号：R576[医药卫生—消化系统]