Pain mechanisms in chronic pancreatitis: of a master and his fire.
Open accessAbstract
BACKGROUND: Unraveling the mechanisms of pain in chronic pancreatitis (CP) remains a true challenge. The rapid development of pancreatic surgery in the twentieth century, usage of advanced molecular biological techniques, and emergence of clinician-scientists have enabled the elucidation of several mechanisms that lead to the chronic, complicated neuropathic pain syndrome in CP. However, the proper analysis of pain in CP should include three main arms of mechanisms: "peripheral nociception," "peripheral/pancreatic neuropathy and neuroplasticity," and "central neuropathy and neuroplasticity." DISCUSSION: According to our current knowledge, pain in CP involves sustained sensitization of pancreatic peripheral nociceptors by neurotransmitters and neurotrophic factors following neural damage. This peripheral pancreatic neuropathy leads to intrapancreatic neuroplastic alterations that involve a profound switch in the autonomic innervation of the human pancreas via "neural remodeling." Furthermore, this neuropathy entails a hyperexcitability of spinal sensory second-order neurons, which are subject to modulation from the brainstem via descending facilitation. Finally, viscerosensory cortical areas react to this central sensitization via spatial reorganization and thus a central neuroplasticity. The present review summarizes the current findings in these arms of mechanisms and introduces a novel concept to consistently describe pain in CP as a "predominantly neuropathic," "mixed-type" pain.
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A neuropathic classification has recently been effectively applied to pain associated with visceral disorders such as pancreatitis, in which abnormal nerve sprouting, like that associated with endometriosis, plays a substantial role in the development of pain.
“Thus, for example, a neuropathic classification has recently been effectively applied to pain associated with visceral disorders such as pancreatitis, in which abnormal nerve sprouting, like that associated with endometriosis, plays a substantial role in the development of pain [23].”
From Sprouted Innervation into Uterine Transplants Contributes to the Development of Hyperalgesia in a Rat Model of Endometriosis (2012) · cites this paper as [23]
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- Authors
- Demir, I. E., Tieftrunk, E., Maak, M., Friess, H., & Ceyhan, G. O.
- Affiliations
- TUM Klinikum (DE)
- Venue
- Langenbeck s Archives of Surgery
- Published
- 2010-12-10
- Volume
- 396
- Issue
- 2
- Pages
- 151-160
- ISSN
- 0023-8236 (ISSN-L)
- 1435-2443
- 1435-2451
- PMC
- PMC3026929
- OpenAlex
- W2005222244
- Cited by
- 101
- References
- 71
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 8 · 2016: 2 · 2015: 10 · 2014: 8 · 2013: 14 · 2012: 5
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Langenbeck s Archives of Surgery (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pancreatitis, neuropathic pain, pain mechanisms, peripheral nociception, neuroplasticity, central sensitization, descending facilitation, brain reorganization
- MeSH terms
- Humans, Neuralgia, Nociceptors, Pain Measurement, Abdominal Pain, Pancreatitis, Chronic
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