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Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study
  1. Daniel K Mullady1,
  2. Dhiraj Yadav1,
  3. Stephen T Amann2,
  4. Michael R O'Connell1,
  5. Michael M Barmada3,
  6. Grace H Elta4,
  7. James M Scheiman4,
  8. Erik-Jan Wamsteker4,
  9. William D Chey4,
  10. Meredith L Korneffel4,
  11. Beth M Weinman4,
  12. Adam Slivka1,
  13. Stuart Sherman5,
  14. Robert H Hawes6,
  15. Randall E Brand7,
  16. Frank R Burton8,
  17. Michele D Lewis9,
  18. Timothy B Gardner10,
  19. Andres Gelrud11,
  20. James DiSario12,
  21. John Baillie13,
  22. Peter A Banks14,
  23. David C Whitcomb1,3,
  24. Michelle A Anderson4,
  25. for the NAPS2 Consortium
  1. 1Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2North Mississippi Medical Center, Tupelo, Mississippi, USA
  3. 3Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana, USA
  6. 6Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA
  7. 7Department of Medicine, Evanston Northwestern Healthcare, Chicago, Illinois, USA
  8. 8Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
  9. 9Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
  10. 10Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
  11. 11Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
  12. 12Department of Medicine, University of Utah Health Science Center, Salt Lake City, Utah, USA
  13. 13Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
  14. 14Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Michelle A Anderson, Department of Internal Medicine, Division of Gastroenterology, 3912 Taubman, Ann Arbor, MI 48109-0362, USA; maaander{at}umich.edu

Abstract

Objective To compare patients with chronic pancreatitis (CP) with constant pain patterns to patients with CP with intermittent pain patterns.

Methods This was a prospective cohort study conducted at 20 tertiary medical centers in the USA comprising 540 subjects with CP. Patients with CP were asked to identify their pain from five pain patterns (A–E) defined by the temporal nature (intermittent or constant) and the severity of the pain (mild, moderate or severe). Pain pattern types were compared with respect to a variety of demographic, quality of life (QOL) and clinical parameters. Rates of disability were the primary outcome. Secondary outcomes included: use of pain medications, days lost from school or work, hospitalisations (preceding year and lifetime) and QOL as measured using the Short Form-12 (SF-12) questionnaire.

Results Of the 540 CP patients, 414 patients (77%) self-identified with a particular pain pattern and were analysed. Patients with constant pain, regardless of severity, had higher rates of disability, hospitalisation and pain medication use than patients with intermittent pain. Patients with constant pain had lower QOL (by SF-12) compared with patients who had intermittent pain. Additionally, patients with constant pain were more likely to have alcohol as the aetiology for their pancreatitis. There was no association between the duration of the disease and the quality or severity of the pain.

Conclusions This is the largest study ever conducted of pain in CP. These findings suggest that the temporal nature of pain is a more important determinant of health-related QOL and healthcare utilisation than pain severity. In contrast to previous studies, the pain associated with CP was not found to change in quality over time. These results have important implications for improving our understanding of the mechanisms underlying pain in CP and for the goals of future treatments and interventions.

  • Abdominal pain
  • chronic pancreatitis
  • quality of life

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Footnotes

  • Funding This work was supported by a grant from the NIH-NIDDK-DK061451 (to DCW).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board at every participating centre and at the University of Pittsburgh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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