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Original research
Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis
  1. Søren S Olesen1,2,
  2. Anna E Phillips3,
  3. Mahya Faghih4,
  4. Louise Kuhlmann1,
  5. Emily Steinkohl2,5,
  6. Jens B Frøkjær2,5,
  7. Benjamin L Bick6,
  8. Mitchell L Ramsey7,
  9. Phil A Hart7,
  10. Pramod K Garg8,
  11. Vikesh K Singh4,
  12. Dhiraj Yadav3,
  13. Asbjørn M Drewes1,2
  14. On behalf of the Pancreatic Quantitative Sensory Testing (P-QST) Consortium
  1. 1Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
  2. 2Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  3. 3Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  4. 4Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  5. 5Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
  6. 6Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  7. 7Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  8. 8Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Søren S Olesen, Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark; soso{at}rn.dk

Abstract

Objective Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).

Design We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.

Results Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.

Conclusion Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.

Trial registration number The study was registered with ClinicalTrials.gov (NCT03434392).

  • chronic pancreatitis
  • endoscopy
  • abdominal pain
  • pancreas
  • pancreatic surgery

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @AsbjornDrewes

  • Contributors SSO: study concept and design, statistical analysis, analysis and interpretation of data, drafting of the manuscript. AEP: data acquisition, analysis and interpretation of data, critical review of manuscript. MF: data acquisition, critical review of manuscript. LKF: data acquisition, critical review of manuscript. ES: data acquisition, imaging analysis, critical review of manuscript. JBF: imaging analysis, critical review of manuscript. BLB: data acquisition, critical review of manuscript. MLR: data acquisition, critical review of manuscript. PAH: study concept and design, analysis and interpretation of data, critical review of manuscript. PKG: analysis and interpretation of data, critical review of manuscript. VKS: analysis and interpretation of data, critical review of manuscript. DY: study concept and design, analysis and interpretation of data, critical review of manuscript. AMD: study concept and design, analysis and interpretation of data, critical review of manuscript. SSO is the guarantor of the article. All authors approved of the final version of the manuscript.

  • Funding AEP received a Young Investigator in Pancreatitis Award from the American Pancreatic Association.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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