Pain in chronic pancreatitis: the role of neuropathic pain mechanisms
- 1Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- 2Center for Sensory-Motor Interactions, Department of Health Science and Technology, Aalborg University, Denmark
- 3Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
- 4Department of Medical Gastroenterology, Haukeland University Hospital, Bergen, Norway
- 5Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus, Denmark
- Professor A M Drewes, Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
- Published Online First 19 June 2008
Pain mechanisms in patients with chronic pancreatitis are incompletely understood and probably multifactorial. Recently, evidence from experimental human pain research has indicated that in many of these patients pain processing in the central nervous system is abnormal and mimics that seen in neuropathic pain disorders. The current review focuses on several lines of evidence supporting this hypothesis. Hence, the spontaneous and postprandial pain in chronic pancreatitis may reflect the characteristic pain features seen in patients with neuropathic pain. Biochemical and histopathological findings in tissues from patients with chronic pancreatitis are similar to those observed in patients with other nerve fibre lesions. Experimental studies have shown that patients with chronic pancreatitis show signs of spinal hyper-excitability counter-balanced by segmental and descending inhibition. Changes in the brain with cortical reorganisation to gut stimulation and increased activity in specific electroencephalographic features characteristic for neuropathic pain are also seen in patients with chronic pancreatitis. Finally, principles involved in the treatment of pancreatic pain have many similarities with those recommended in neuropathic pain disorders. In conclusion, a mechanism-based understanding of pain in chronic pancreatitis may have important implications for the treatment.
Funding: The study was supported from “SparNord Fonden”, “Det Obelske Familiefond” and The Danish Health Research Council.
Competing interests: None.