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Pain in chronic pancreatitis: The role of neuropathic pain mechanisms
  1. Asbjørn Mohr Drewes (drewes{at}smi.auc.dk)
  1. Aalborg Hospital, Denmark
    1. Anne Lund Krarup (annelundkrarup{at}gmail.com)
    1. Aalborg Hospital, Denmark
      1. Sönke Detlefsen (s.detlefsen{at}gmx.net)
      1. Aalborg Hospital, Denmark
        1. Marie-Louise Malmstrøm (malmstroem{at}gmail.com)
        1. Aalborg Hospital, Denmark
          1. Georg Dimcevski (georg.dimcevski{at}qdc.nu)
          1. Haukeland Hospital, Norway
            1. Peter Funch-Jensen (funchjensen{at}gmail.com)
            1. Århus Hospital, Denmark

              Abstract

              One of the most important symptoms in chronic pancreatitis (CP) is constant or recurrent abdominal pain that is present in 80-90 % of patients during the course of the disease 1. Pancreatic pain presents characteristically with severe dull epigastric pain, often radiating directly to the back. The pain is often recurrent, intense, and long-lasting and may be associated with malnutrition, narcotic addiction, and major socio-economical problems. Pain mechanisms are incompletely understood and probably multifactorial. In some cases the reason for the pain is obvious, such as extrapancreatic (e.g., peptic ulcer or bile duct and duodenal stenosis due to extensive pancreatic fibrosis and inflammation) or intrapancreatic (e.g., pseudocysts) complications. However, in most patients the source of the pain remains unknown. In these cases the following pathophysiological mechanisms have been suggested: 1) Increased intrapancreatic pressure either within the pancreatic duct or in the parenchyma causing tissue ischaemia; 2) Inflammation in the pancreas; and 3) alterations in pancreatic nerves, including an increase in nerve fibre diameter and evidence for neurogenic inflammation 2-4. Genetic factors probably also play a role in an individual’s pain experience 4. Because the pain mechanisms are poorly understood, treatment is often empirical and insufficient.

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