Patients with chronic pancreatitis who report continuous pain have higher pain severity, greater utilization of pain medications, and lower quality of life compared with patients who report only intermittent pain; many patients with chronic pancreatitis tend to report alternating pain patterns during the course of their disease, according to study findings published in the journal Gut.
The prospective, longitudinal study included 1131 patients with chronic pancreatitis from 30 Dutch hospitals, all of whom were registered in the Dutch Chronic Pancreatitis Registry (CARE) between 2011 and 2018. The nationwide CARE registry was designed to study pain patterns in this patient population. Patients were subdivided into groups reporting continuous pain (n=589), intermittent pain (n=231), and no pain (n=311). These pain patterns were evaluated by an annual questionnaire.
Patients who reported continuous pain had higher pain severity (mean Visual Analogue Scale [VAS] pain score, 57±28 for continuous pain vs 48±29 for intermittent pain vs 0±0 for no pain; P <.001), used more opioids (strong opioids: 37% vs 16% vs 1%; P <.001) and neuropathic pain drugs (11% vs 4% vs 3%; P =.001), and had lower quality of life (physical health scale: 38±11 vs 41±10 vs 49±9; P =.005; mental health scale: 44±12 vs 47±11 vs 49±11; P =.002).
No differences were found between the reported pain patterns in terms of morphological findings on imaging, disease duration, and treatment. Over a median 47-months of follow-up, approximately 61% of the 905 patients with long-term follow-up data alternated ≥1 time between pain patterns. These observed alternations were associated with the VAS pain intensity score (odds ratio [OR], 0.97; 95% CI, 0.94-0.99; P =.04). Surgery was the only factor associated with a change from “pain” to “no pain” (OR, 11.83; 95% CI, 4.40-31.82; P <.001).
A limitation of this study was the focus on only physical outcomes and the lack of additional assessments for social, psychological, and behavioral outcomes and treatment.
Based on these findings, the researchers suggest that, “Pain patterns are therefore merely a feature of how severity of pain is experienced in patients with chronic pancreatitis.”
Disclosure: This clinical trial was supported by Mylan. Please refer to the original article for a full list of disclosures.
Kempeneers MA, Issa Y, Verdonk RC, et al. Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study. Gut. 2021;70(9):1724-1733. doi:10.1136/gutjnl-2020-322117