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

Pancreatic calculi, once considered pathologic and even "reportable," are frequently observed in patients with chronic pancreatitis. They are not to be considered pathognomonic of chronic alcoholism, because they are frequently observed in other types of chronic pancreatitis, such as the tropical, Afro-Asian, hereditary, idiopathic, and senile varieties. The widely recognized concept that appearance of calculi indicates the end stage of the disease is challenged in this article. The subject of pancreatic lithogenesis is controversial, but pancreatic stone protein has been extensively studied by one major group. Techniques to remove calculi by endoscopy or extracorporeal shock wave lithotripsy are available, but it is not clear whether they serve only a cosmetic purpose or actually help in alleviating pain and arresting the progress of disease.
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PMID:Pancreatic stones. 226 23

The cause of pain in chronic pancreatitis appears to be related to ductal and parenchymal hypertension and possibly to pancreatic ischemia. The management of pain needs a multidisciplinary approach. Medical measures such as abstinence from alcohol and therapy with mild analgesics are useful. Surgery should be considered when the pain begins to interfere with the patient's quality of life. Ductal drainage operations may be indicated when the duct is dilatated. The alternative is pancreatic resection, which, although safe and effective, creates diabetes when much of the pancreas is removed. Newer operations that relieve pain while preserving function are being devised.
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PMID:The cause and management of the pain of chronic pancreatitis. 226 24

Extracorporeal shock-wave fragmentation of pancreatic stones is a complementary non-surgical treatment in selected patients with chronic pancreatitis. The procedure has proven to be safe and technically effective. Preliminary clinical results indicate therapeutic success rates in terms of pain disappearance or reduction in more than 90% of the patients. The indication should be taken into consideration before surgical intervention.
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PMID:[Extracorporeal shockwave lithotripsy of pancreatic calculi]. 227 64

The armamentarium of the pancreatic surgeon must include multiple operative techniques, to be adapted to the clinical and anatomical findings in the patient with chronic pancreatitis. Pancreaticoduodenectomy is an essential component of this armamentarium. Its indications and limitations require continued refinement. Pancreaticoduodenectomy (Whipple operation) provides excellent results in the relief of the pain of chronic pancreatitis. The incidence of reoperation for control of pain after this procedure is less than after drainage procedures. The postoperative mortality rate in recent report is less than 2%. Whereas resection of pancreatic tissue diminishes pancreatic function, the metabolic deficits are partially compensated by the better nutritional status resulting from pain relief and discontinuation of narcotics. In experienced hands, pancreaticoduodenectomy would appear to be the procedure of choice in patients with small pancreatic ducts. In selected patients, it appears to be a good procedure and, possibly, the operation of choice when the disease is predominantly present in the head of the pancreas and/or the uncinate process, especially when strictures involve the common bile duct and duodenum. The authors prefer the procedure when a hard, chronically-inflamed mass is present in the head of the pancreas. In our experience, if the suspicion of malignancy of the head of the pancreas persists at operation, pancreaticoduodenectomy is the procedure of choice. Before undertaking resection, the individual surgeon must assess his/her own experience; a low risk is essential. The continuing alcoholic is not a candidate for pancreaticoduodenectomy. Those who will not stop drinking should seldom be accepted for resection. The same limitation exists for the narcotic addict, but few such patients are encountered today. In the authors' experience, the operation is excellent for the relief of pain. It is the lifestyle of the continuing alcoholic that poses the more significant problem.
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PMID:Pancreaticoduodenectomy (Whipple resection) in the treatment of chronic pancreatitis. 230 89

In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely free of abdominal pain; 67% returned to their former occupation. After a follow-up period of 3.6 years, glucose metabolism was unchanged in 81.7% of the patients, in 10.1% it deteriorated, and in 8.3% it improved permanently. In patients with severe chronic pancreatitis and an inflammatory mass in the head of the pancreas, a duodenum-preserving resection of the head of the pancreas is an alternative procedure to the Whipple operation. The surgical technique of the duodenum-preserving resection includes 2 major steps: first, subtotal resection of the head of the pancreas conserving the duodenum; second, restitution of the exocrine pancreatic secretory flow from the body and tail of the pancreas by using the first jejunal loop as an interposition. In comparison to the Whipple procedure, the duodenum-preserving resection of the head of the pancreas in chronic pancreatitis spares the patient a gastric resection, a duodenectomy, and a common bile duct resection. With respect to long-lasting pain relief and preservation of the endocrine function of the pancreas, duodenum-preserving resection of the head is a highly effective surgical procedure with a low early and late morbidity and mortality due to the limited surgical resection.
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PMID:Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head. 230 90

To denervate the pancreas of sensory afferents, 15 patients with intractable pain of chronic alcohol induced pancreatitis underwent left transthoracic splanchnicectomy with concomitant bilateral truncal vagotomy. All were malnourished and 11 were addicted to opiates. No respite had been obtained from 33 previous operative procedures. Each patient experienced almost immediate pain relief. Five, however, later had return of pain, but only to the right epigastrium. These five then underwent right transthoracic splanchnicectomy, after which four noted complete and apparently permanent disappearance of pain. In those 14 with a successful outcome there has been a 29 per cent mean increase in body weight, break of hard drug addition in ten of the 11 so afflicted, and return to gainful work or a relatively normal lifestyle in all 14 at a mean follow-up of 16 months. Although 11 of the 14 do have delayed gastric emptying, only one has required a drainage procedure. There have been no other late complications. This approach for control of incapacitating pain in chronic pancreatitis is both safe and simple and at the same time it appears to be reasonably reliable.
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PMID:Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis. 232 94

Endoprothetic stenting of the pancreatic duct is reported in limited series. Twelve patients are presented here. In five patients with confirmed or suspected pancreatic malignancy, pain and diarrhea subsided or disappeared, and two patients had a temporary gain in weight. Four patients with chronic pancreatitis all experienced relief of symptoms. One patient with a pancreatic abscess improved temporarily. A postoperative pancreatic fistula healed within two weeks. One patient with a stone in the pancreatic duct became temporarily free from pain. Two patients had minor complications. Efficiency of pancreatic drainage is difficult to evaluate. However, all our patients seemed to benefit from the treatment.
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PMID:[Pancreatic duct prosthesis]. 233 49

Between 1982 and 1988 47 patients underwent surgery for chronic pancreatitis at our institution. The main etiological factor was alcohol (41 cases). The mean age of the patients with alcohol-induced chronic pancreatitis was 15 years below that of the other patients. Calcifications were found in 27 patients at the time of surgery. Calcifications and exocrine insufficiency increased from 40% and 27% to 80% and 79% respectively if the history was shorter than 5 years or more than 10 years. The main indications for surgery were cholestatic jaundice (23 cases) and pseudocysts (22 cases), while only 6 patients had surgical treatment for pain alone. Only one of seven recurrences of chronic pancreatitis were in a patient with a history of more than ten years. Operative mortality was 4%. The length of the history of chronic pancreatitis influences the indication for surgery, the surgical technique and postoperative prognosis. Studies comparing different operative techniques are only of value if they take the natural history of the disease into account.
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PMID:[Surgery of chronic pancreatitis]. 233 55

The association between histopathological changes and the incidence of abdominal pain in patients with chronic pancreatitis was reviewed from published reports, and compared with that in our own series (n = 65). Recurrent tissue necrosis caused by autodigestion, and the formation of pseudocysts, are the likely causes of the intermittent pain that marks the early stages of chronic pancreatitis. In contrast, the persistent pain of advanced chronic pancreatitis is associated with incomplete duct obstruction in a pancreas that is still able to secrete. The cause of persistent pain may therefore be segmental distension of the walls of the duct as a result of focally increased pressure. Perineural scarring has been seen in both painful and painless chronic pancreatitis.
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PMID:Pathology of chronic pancreatitis and pancreatic pain. 234 44

The association between pain and exocrine pancreatic function was re-evaluated in 56 patients with chronic pancreatitis to see if residual function of the gland may evoke outflow obstruction resulting in pain. No significant differences were found in the degrees of pancreatic dysfunction among three groups with different degrees of pain (no pain, n = 7; moderate pain, n = 21; and severe pain, n = 28), but patients with more impairment of exocrine pancretic function tended to have less pain. In patients with no pain the mean (SD) peak serum concentration of fluorescein was 2.0 (0.2) micrograms/l, in those with moderate pain it was 2.6 (0.1), and in those with severe pain it was 3.4 (0.1). No significant differences were found between the degree of pain and the duration of the disease, which was 5.5 (0.3) years in the group with no pain, 3.5 (0.2) in patients with moderate pain, and 3.8 (0.1) in those with severe pain. We conclude that outflow obstruction may affect some patients, but is not the only cause of pain. Patients with severe pancreatic dysfunction and steatorrhoea often present with pain, so either obstruction of the residual secretions, or inflammatory activity impinging on nerve endings in fibrotic tissue, may also cause pain. The causes vary, and there is often more than one, so optimal management implies thorough investigation of each patient and long term follow up.
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PMID:Relationship between pancreatic function and pain in chronic pancreatitis. 234 45


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