Pain and opioid use in chronic pancreatitis
Abstract
OBJECTIVE: Opioid therapy for pain in chronic pancreatitis (CP) is associated with tolerance and possibly opioid-induced hyperalgesia. We thus examined opioid use and pain rating in CP patients. METHODS: Medical records of patients with established CP treated at the University of Pittsburgh Medical Center's Digestive Disorders Center between April 2008 and December 2009 were retrospectively reviewed. RESULTS: Two hundred nineteen unique patients (53% men; age, 50 ± 1 years) were identified. At least moderate pain was initially present in 37% of the patients. Half (51%) of the patients received opioids (average morphine equivalent, 78.1 ± 12.4 mg/d). Pain severity correlated with age (r = -0.22), history of alcohol abuse (r = 0.14), affective spectrum disorders (r = 0.14), presence of coexisting pain syndromes (r = 0.24), opioid use (r = 0.49), and days with concerns about physical (r = 0.55) or mental problems (r = 0.35). In contrast, computed tomography-defined pancreatic abnormalities (calcification, pseudocysts, ductal stones, or dilation) did not correlate with pain rating. Regression analysis identified age, days with physical problems, and a coexisting chronic pain syndrome as best independent predictors of pain. CONCLUSIONS: Chronic pancreatitis etiology, especially alcohol use, and psychosocial factors are important determinants of pain severity in CP. Successful management thus needs to go beyond treatment of changes in pancreatic morphology to effectively improve quality of life and utilization of medical resources.
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Chronic opioids have limited efficacy and substantial risk for adverse side effects in painful CP.
“In clinical practice, painful CP is oftentimes managed with chronic opioids (7), which unfortunately have limited efficacy and substantial risk for adverse side effects.”
From Internet Cognitive-Behavioral Therapy for Painful Chronic Pancreatitis: A Pilot Feasibility Randomized Controlled Trial (2021) · cites this paper as [7]
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Opioid Use for Acute Pancreatitis—Toward a Research Agenda to Optimize Patient Safety
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Financial Toxicity in Patients With Chronic Pancreatitis
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Building a Quality Practice in Chronic Pancreatitis
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Tissue Mass Spectrometry: How Solid Is Our Future?
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- Authors
- Nusrat, S., Yadav, D., & Bielefeldt, K.
- Affiliations
- University of Pittsburgh Medical Center (US)
- Venue
- Pancreas
- Published
- 2012-03
- Volume
- 41
- Issue
- 2
- Pages
- 264-270
- ISSN
- 0885-3177 (ISSN-L)
- OpenAlex
- W2032114457
- Cited by
- 67
- References
- 43
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 10 · 2020: 4 · 2019: 8 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 7 · 2013: 4
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pancreas (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- chronic pancreatitis, pain intensity, opioid use, morphine milligram equivalents, opioid tolerance, opioid-induced hyperalgesia, alcohol abuse, affective spectrum disorders, predictors of pain, psychosocial factors, pancreatic calcification, pancreatic pseudocyst
- MeSH terms
- Analgesics, Opioid, Analysis of Variance, Female, Humans, Male, Middle Aged, Pain, Pain Measurement, Pennsylvania, Quality of Life, Regression Analysis, Retrospective Studies, Risk Factors, Severity of Illness Index, Chi-Square Distribution, Treatment Outcome, Risk Assessment, Pancreatitis, Chronic
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