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Cited by 101Pain Mechanisms and TreatmentsPancreatitis Pathology and TreatmentPain Management and Treatment

The DOI matches its Crossref record; 71 of the 71 references it cites were found in a registry or an index.

Pain mechanisms in chronic pancreatitis: of a master and his fire.

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Demir, Ihsan Ekin, Tieftrunk, Elke, Maak, Matthias, Friess, Helmut, Ceyhan, Güralp Onur·2011·Langenbeck s Archives of Surgery
DOI 10.1007/s00423-010-0731-1PMC PMC3026929
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Abstract

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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Fig. 1 Main actors in the generation of pain in chronic pancreatitis (CP). The neuropathic pain syndrome in CP involves numerous molecular and morphological alterations at intrapancreatic (peripheral) and extrapancreatic (dorsal root ganglia/DRG, spinal cord, brainstem, and cerebrum) sites. The increased presence of nociceptive signals in the periphery as mediated by neurotransmitters and neurotrophic factors is paralleled by prominent neural damage and numerous intrapancreatic neuropathic/neuroplastic alterations. At the same time, DRG and spinal cord neurons exhibit a hypersensitive state which is subject to modulation from the brainstem over descending facilitation. Finally, the cerebral cortex adapts to these caudal alterations by increasing its basal activity and changing its spatial conformation in viscerosensory areas. Please refer to the manuscript for further details and the respective references
Fig. 1 Main actors in the generation of pain in chronic pancreatitis (CP). The neuropathic pain syndrome in CP involves numerous molecular and morphological alterations at intrapancreatic (peripheral) and extrapancreatic (dorsal root ganglia/DRG, spinal cord, brainstem, and cerebrum) sites. The increased presence of nociceptive signals in the periphery as mediated by neurotransmitters and neurotrophic factors is paralleled by prominent neural damage and numerous intrapancreatic neuropathic/neuroplastic alterations. At the same time, DRG and spinal cord neurons exhibit a hypersensitive state which is subject to modulation from the brainstem over descending facilitation. Finally, the cerebral cortex adapts to these caudal alterations by increasing its basal activity and changing its spatial conformation in viscerosensory areas. Please refer to the manuscript for further details and the respective referencesCC BY-NC · PubMed Central

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Research works printed but not linked: 1

  1. Hesse H (1971) Lektüre für Minuten. Suhrkamp Verlag, Frankfurt

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Metadata

Authors
Demir, I. E., Tieftrunk, E., Maak, M., Friess, H., & Ceyhan, G. O.
Affiliations
TUM Klinikum (DE)
ORCID
Venue
Langenbeck s Archives of Surgery
Publisher
Springer Science and Business Media LLC
Published
2010-12-10
Volume
396
Issue
2
Pages
151-160
ISSN
  • 0023-8236 (ISSN-L)
  • 1435-2443
  • 1435-2451
DOI
10.1007/s00423-010-0731-1
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
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 (medical) › 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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