TY - JOUR
T1 - Pain patterns in chronic pancreatitis
T2 - a nationwide longitudinal cohort study
AU - Kempeneers, Marinus A
AU - Issa, Yama
AU - Verdonk, Robert C
AU - Bruno, Marco
AU - Fockens, P
AU - van Goor, Harry
AU - Alofs, Eline
AU - Bollen, Thomas L
AU - Bouwense, Stefan
AU - van Dalen, Anne S H M
AU - van Dieren, Susan
AU - van Dullemen, Hendrik M
AU - van Geenen, Erwin-Jan
AU - Hoge, Chantal
AU - van Hooft, Jeanin E
AU - Kager, Liesbeth M
AU - Keulemans, Yolande
AU - Nooijen, Lynn E
AU - Poley, Jan-Werner
AU - Seerden, Tom C J
AU - Tan, Adriaan
AU - Thijs, Willem
AU - Timmer, Robin
AU - Vleggaar, Frank
AU - Witteman, Ben
AU - Ahmed Ali, Usama
AU - Besselink, Marc G
AU - Boermeester, Marja A
AU - van Santvoort, Hjalmar C
N1 - Funding Information:
Contributors The manuscript has been read and approved by all authors. Funding This study is supported by an unrestricted grant from ’Mylan NV.’ Competing interests None declared. Patient consent for publication Not required. Ethics approval This study was performed in accordance with the principles of the Declaration of Helsinki and the human research laws in the Netherlands. CARE was approved by the medical ethical committee of the University Medical Centre Utrecht, and received an exempt status due to its descriptive nature (ID: AvG/rc/10/05699, 17 March 2010). All patients provided written informed consent.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - OBJECTIVE: Pain in chronic pancreatitis is subdivided in a continuous or intermittent pattern, each thought to represent a different entity, requiring specific treatment. Because evidence is missing, we studied pain patterns in a prospective longitudinal nationwide study.DESIGN: 1131 patients with chronic pancreatitis (fulfilling M-ANNHEIM criteria) were included between 2011 and 2018 in 30 Dutch hospitals. Patients with continuous or intermittent pain were compared for demographics, pain characteristics, quality of life (Short-Form 36), imaging findings, disease duration and treatment. Alternation of pain pattern and associated variables were longitudinally assessed using a multivariable multinomial logistic regression model.RESULTS: At inclusion, 589 patients (52%) had continuous pain, 231 patients (20%) had intermittent pain and 311 patients (28%) had no pain. Patients with continuous pain had more severe pain, used more opioids and neuropathic pain medication, and had a lower quality of life. There were no differences between pain patterns for morphological findings on imaging, disease duration and treatment. During a median follow-up of 47 months, 552 of 905 patients (61%) alternated at least once between pain patterns. All alternations were associated with the Visual Analogue Scale pain intensity score and surgery was only associated with the change from pain to no pain.CONCLUSION: Continuous and intermittent pain patterns in chronic pancreatitis do not seem to be the result of distinctly different pathophysiological entities. The subjectively reported character of pain is not related to imaging findings or disease duration. Pain patterns often change over time and are merely a feature of how severity of pain is experienced.
AB - OBJECTIVE: Pain in chronic pancreatitis is subdivided in a continuous or intermittent pattern, each thought to represent a different entity, requiring specific treatment. Because evidence is missing, we studied pain patterns in a prospective longitudinal nationwide study.DESIGN: 1131 patients with chronic pancreatitis (fulfilling M-ANNHEIM criteria) were included between 2011 and 2018 in 30 Dutch hospitals. Patients with continuous or intermittent pain were compared for demographics, pain characteristics, quality of life (Short-Form 36), imaging findings, disease duration and treatment. Alternation of pain pattern and associated variables were longitudinally assessed using a multivariable multinomial logistic regression model.RESULTS: At inclusion, 589 patients (52%) had continuous pain, 231 patients (20%) had intermittent pain and 311 patients (28%) had no pain. Patients with continuous pain had more severe pain, used more opioids and neuropathic pain medication, and had a lower quality of life. There were no differences between pain patterns for morphological findings on imaging, disease duration and treatment. During a median follow-up of 47 months, 552 of 905 patients (61%) alternated at least once between pain patterns. All alternations were associated with the Visual Analogue Scale pain intensity score and surgery was only associated with the change from pain to no pain.CONCLUSION: Continuous and intermittent pain patterns in chronic pancreatitis do not seem to be the result of distinctly different pathophysiological entities. The subjectively reported character of pain is not related to imaging findings or disease duration. Pain patterns often change over time and are merely a feature of how severity of pain is experienced.
KW - chronic pancreatitis
KW - endoscopy
KW - intractable pain
KW - pancreatic surgery
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=85096023508&partnerID=8YFLogxK
U2 - 10.1136/gutjnl-2020-322117
DO - 10.1136/gutjnl-2020-322117
M3 - Article
C2 - 33158979
SN - 0017-5749
VL - 70
SP - 1724
EP - 1733
JO - Gut
JF - Gut
IS - 9
ER -