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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic pancreatitis (CP) is a rare but serious disease with high morbidity and mortality. Its exact etiology remains uncertain, but several associated conditions have been identified. Geographical distribution of CP can be linked to alcoholism, especially in countries with high-protein, high-fat diets. In Afro-Asiatic countries with protein malnutrition, however, CP is frequently observed in children and young nonalcoholic adults from the poorest segments of these societies. To analyze the natural history of CP, besides etiology three additional main factors have to be considered, namely clinical pattern and therapy (surgery), pancreatic function (endocrine and exocrine), and morphology. During progress of the disease clinical picture, morphology and pancreatic function have typical correlative changes. Basically, from this viewpoint, three typical models of the disease can be distinguished: (1) early stage of uncomplicated CP; (2) late stage of uncomplicated CP, and (3) complicated CP, a disease stage which is characterised by local complications (chiefly pseudocysts and duct obstruction). The main concept of the natural history of CP bases on the thesis that CP burns itself out with spontaneous relief of pain, i.e. persistent freedom from pain occurs parallel with severe pancreatic dysfunction in the late stage of the disease. In the clinical picture and long-term course, nonalcoholic CP differs in certain essential respects from alcoholic CP; however, the two forms do not differ essentially as regards mortality and survival.
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PMID:Etiology and natural history of chronic pancreatitis. 147 86

Relief of pain in chronic pancreatitis is the major problem warranting surgical treatment in this disease. The mechanism of pain is largely unknown and several types of operation have been devised for treatment. Side-to-side pancreaticojejunostomy (Partington-Rochelle) and pancreaticoduodenectomy according to Whipple have stood the test of time. Recently, new surgical options have been explored like the operation according to Beger, segmental autotransplantation, and duodenum-preserving total pancreatectomy. Because of the reluctance to refer this type patient for surgery, treatment with analgesic drugs is continued for quite some time and once analgesia addiction has developed clinical judgement in these patients is severely hampered. Surgery can be performed with 70-80% success and with limited morbidity as well as low mortality. For these reasons surgery should be discussed early in the disease if pain becomes a major problem. If these patients are operated prior to analgesia addiction, maybe the long-term prognosis will improve. The diagnostic and surgical approach will be discussed in detail with a plea for considering surgery early in the course of disease.
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PMID:Surgical treatment of painful chronic pancreatitis: an unresolved problem? 147 87

Thirty-five patients with chronic pancreatitis (CP) treated over a 15-year-period were studied. There were 29 men and 6 women with a mean age of 47 years (range 21-67). Twenty-seven (77%) were chronic alcoholics, two (6%) had gallstones, one had stenosis of the Ampulla of Vater and in five (14%) no obvious cause was found. Thirty patients (86%) presented with abdominal pain. Chronic diarrhoea was present in 8 (23%), and steatorrhoea was documented in 6 of these. Fifteen (43%) had pancreatic calcifications. Five developed pseudocysts and 16 (46%) developed diabetes mellitus. Twelve patients required surgery. Three continue to have severe recurrent relapses of pain but the majority (91%) have had a relatively stable course with medical management.
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PMID:Chronic pancreatitis in Jamaica. 152 34

Pancreatic tissue obtained from 26 patients with alcoholic chronic pancreatitis (ACP), nine patients with nonalcoholic idiopathic chronic pancreatitis (NAICP), and seven patients with obstructive chronic pancreatitis (OCP) was studied in an attempt to determine whether clinical or etiologic differences have a morphologic counterpart. Histologically it was easy to distinguish ACP from OCP occurring distal to an obstruction of the pancreatic duct. Nine patients with NAICP showed histological features similar to those found in ACP. Plugs and calcifications were found as frequently in NAICP as in ACP, suggesting that NAICP, whatever the etiology, is truly pancreatolithiasis, which leads to slowly progressive fibrosis and acinar atrophy in the obstructed pancreatic lobule. Nerve fibers were found to be more numerous in all disease categories. Inflammatory foci of lymphocytes associated with nerves were observed in 57 and 35% of cases with OCP and ACP, respectively, but only in one patient with NAICP. These findings may constitute a pathological basis for the existing clinical data showing that NAICP frequently runs a pain-free course.
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PMID:Histological study of alcoholic, nonalcoholic, and obstructive chronic pancreatitis. 155 68

In a comparative study of tropical chronic pancreatitis (TCP) and alcoholic chronic pancreatitis (ACP) occurring in the same population, we analyzed the clinical profile of 50 patients of ACP seen over the past 3 years at our centers and compared this with the profile of our TCP patients. A majority (75%) of patients in both groups belonged to Tamil Nadu and 90% had never consumed cassava. Whereas TCP occurred in young subjects of both sexes, ACP patients were all males and presented at an older age. The frequency of pain, diabetes, and pancreatic calcification was similar in the two groups. Patients in both groups were lean, but signs of severe malnutrition were rare. Prediabetic patients had normal body mass index. There were striking differences in radiological appearance of pancreatic calculi in TCP and ACP. Malignancy of the pancreas was present in three patients with TCP. Benign bile duct stenosis was seen in three patients with ACP but not in TCP. Compared to ACP seen in the West, our ACP patients had a shorter duration of symptoms in spite of having advanced disease. TCP and ACP have distinct clinical profiles and it is possible that some environmental factors may hasten the progress of ACP in the tropics.
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PMID:Comparative study of the clinical profiles of alcoholic chronic pancreatitis and tropical chronic pancreatitis in Tamil Nadu, south India. 155 46

The present study describes various strategies of coping with illness as observed in pancreatectomy patients, a group of patients which has not been investigated before in this field of research. Questionnaire data obtained from a sample of n = 134 were analyzed with regard to sociodemographic (age, sex) and medical characteristics (indication for surgery: chronic pancreatitis vs. pancreatic carcinoma; outcome after surgery: diabetes, hypoglycemia, pain). The relationships between ways of coping and several adaptation criteria were investigated. The question is put up to discussion, if it is possible to clearly separate emotion as a way of coping and emotion as an outcome of coping.
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PMID:Coping and adaptation in pancreatectomized patients: a somatopsychic perspective. 158 94

The treatment of chronic pancreatitis commonly yields disappointing results. Patients with chronic pancreatitis and a dilated pancreatic duct can be treated by longitudinal pancreaticojejunostomy. In order to evaluate the procedure, 20 patients undergoing pancreaticojejunostomy were followed for a median time of more than 5 years. Their clinical characteristics and outcomes have been compared with a group of 43 patients with chronic pancreatitis and small pancreatic ducts. There were no differences between the two groups in the major epidemiological parameters, except that calcification in the gland was more frequently noted in those with large ducts. The operation of longitudinal pancreaticojejunostomy could be accomplished with an acceptable morbidity. There was one death in the postoperative period. Seventy-six per cent of patients were found to have benefited clinically at five years, compared with 48% of those with small duct disease. This difference was statistically significant. Patients who benefited were defined by four factors; they were carrying out their usual occupation at the time of surgery, they were not narcotic dependent at the time of surgery, they had a pancreatic duct width greater than 7 mm and, they had totally abstained from alcohol from before the operation to the time of follow-up. Longitudinal pancreaticojejunostomy probably remains the best surgical treatment for suitable patients with chronic pancreatitis. The operation should only be performed when the pancreatic duct is greater than 7 mm in width. In such patients the operation produces considerable improvement of pain with minimal metabolic disturbance.
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PMID:Pancreaticojejunostomy for chronic pancreatitis. 158 99

Frey's duodenum-preserving resection is one of three techniques of conservative surgery for the relief of pain in chronic calcifying pancreatitis of the pancreatic head described since 1985 [2, 3, 7]. In our view Frey's procedure is the most satisfactory of the three techniques. It does not require transsection of the pancreas and is suitable to deal with ductal stenoses and stones not only in the pancreatic head but also in the body and tail of the pancreas. We have been impressed by the quality of pain relief obtained and by the smoothness of the postoperative course following this operation. Duodenum-preserving resection of the pancreatic head is greatly facilitated by the use of the ultrasonic dissector which permits dissection in a nearly bloodless field and is particularly suitable for achieving decompression of the intrapancreatic part of the common bile duct by dissecting anyway fibrosed and calcified tissue. The techniques of duodenum-preserving resection of the head of the pancreas are based on principles which have stood the test of time. They have, however, been introduced only a few years ago, and their role in the treatment of severe pain associated with chronic pancreatitis yet awaits more precise definition.
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PMID:[The Frey operation: a valuable enrichment of therapeutic possibilities of chronic calcifying pancreatitis]. 159 27

Between January 1985 and September 1989, 75 patients presenting with severe chronic pancreatitis with distal stricture and upstream dilatation underwent stenting of the main pancreatic duct (MPD) through the major papilla (n = 54) or minor papilla (n = 21) in order to drain the predominant duct through a 10F plastic prosthesis. All patients had undergone biliary and pancreatic sphincterotomy with a few cases of complications, and the majority (84%) also ESWL in the period from October 1987 onwards without complications. Relief of pain (94%) occurred parallel to a decrease in the MPD diameter. In a mean follow-up period of 37 months improvement of the nutrition status and relief of pain was seen. Clogging of these large plastic stents was treated by replacement or by another endoscopic or surgical procedure. Complications were treated endoscopically. Further measures necessary due to failure of stenting consisted of laterolateral pancreatico-jejunostomy in 15% of patients and placement of self-expanding 18F metal mesh stents in 29%. There was no mortality due to surgery. It is concluded that stenting of distal strictures in the MPD can lead to rapid resolution of pancreatic pain due to ductal hypertension and is the best means for determining the cause of pain, providing an alternative to surgery. Significant improvement of a stricture by prolonged stenting is however unusual, and such patients treated endoscopically require close follow-up with stent replacement approximately once a year.
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PMID:Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. 160 13

The role of operation, particularly pancreaticojejunostomy, in the treatment of abdominal pain from chronic pancreatitis is controversial, but relief of pancreatic duct obstruction may decrease the rate of pancreatic organ failure. Our results over 6 years in 13 carefully selected patients suggest that pancreatic drainage does relieve pain but is less effective in preventing pancreatic exocrine failure. Pain was the indication for operation in all patients.
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PMID:Pancreaticojejunostomy for severe symptomatic chronic pancreatitis. 161 Jul 24


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