Pain treatment for chronic pancreatitis

Pain is a frustrating, sometimes debilitating aspect of ongoing (chronic) pancreatitis. Many people have pain for many years.

Pain may decrease as the damaged pancreas loses its ability to produce enzymes, but it may take years for the pancreas to stop producing enzymes. In many people, this process never occurs.

If you are having debilitating pain from chronic pancreatitis, you may be referred to a pain clinic.

Several treatments can be tried to relieve persistent pain. Most of the nonsurgical measures below (except for analgesics) have not yet been proven to reduce pain in most people.¹

• Analgesics. Nonnarcotic (and therefore nonaddicting) pain medicines are tried first. If these provide no relief, the narcotic meperidine (Demerol) or morphine may be given to relieve sudden episodes of inflammation. Doctors monitor use of narcotics, because they do not want people to become dependent on the medicines. These medicines also have side effects and risks, such as constipation, falls, and slowed breathing.
• Tricyclic antidepressants. These medicines (such as Elavil, Tofranil, or Desyrel) may help people sleep and cope with pain and depression.
• Pancreatic enzyme supplements. People can take oral enzyme supplements, which may reduce pain in some people, particularly those who have mild or moderate disease.²
• Acid reducers. H2-receptor-blocking medicines (such as Tagamet, Pepcid, or Zantac) and proton pump inhibitors (such as Prilosec or Prevacid) may be given along with enzymes to reduce the production of stomach acid, which can stimulate the pancreas.
• Stents. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) can be used to place small supports (stents) in a narrow pancreatic duct.
• Celiac plexus nerve block. An injection of alcohol or corticosteroids into this bundle of abdominal nerves may provide temporary relief.
• Surgery. Pain may be reduced by removing stones from the pancreas and draining pancreatic ducts. For some chronic pain, total pancreatectomy, or removal of the pancreas, may be considered.

Citations

1. American Gastroenterological Association (1998). American Gastroenterological Association technical review: Treatment of pain in chronic pancreatitis. Gastroenterology, 115(3): 765–776.

2. Mergener K, Baillie J (1997). Chronic pancreatitis. Lancet, 350(9088): 1379–1385.