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Pancreas
Original research
Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study
  1. Marinus A Kempeneers1,
  2. Yama Issa1,
  3. Robert C Verdonk2,
  4. Marco Bruno3,
  5. P Fockens4,
  6. Harry van Goor5,
  7. Eline Alofs1,
  8. Thomas L Bollen6,
  9. Stefan Bouwense5,
  10. Anne S H M van Dalen1,
  11. Susan van Dieren1,
  12. Hendrik M van Dullemen7,
  13. Erwin-Jan van Geenen8,
  14. Chantal Hoge9,
  15. Jeanin E van Hooft4,
  16. Liesbeth M Kager10,
  17. Yolande Keulemans11,
  18. Lynn E Nooijen1,
  19. Jan-Werner Poley3,
  20. Tom C J Seerden12,
  21. Adriaan Tan13,
  22. Willem Thijs14,
  23. Robin Timmer2,
  24. Frank Vleggaar15,
  25. Ben Witteman16,17,
  26. Usama Ahmed Ali18,
  27. Marc G Besselink1,
  28. Marja A Boermeester1,
  29. Hjalmar C van Santvoort18,19
  30. for the Dutch Pancreatitis Study Group
  1. 1 Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
  2. 2 Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
  3. 3 Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
  4. 4 Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
  5. 5 Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
  6. 6 Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
  7. 7 Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
  8. 8 Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
  9. 9 Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
  10. 10 Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
  11. 11 Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
  12. 12 Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
  13. 13 Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
  14. 14 Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, The Netherlands
  15. 15 Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
  16. 16 Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
  17. 17 Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
  18. 18 Department of Surgery, University Medical Centre, Utrecht, The Netherlands
  19. 19 Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
  1. Correspondence to Professor Hjalmar C van Santvoort, Department of Surgery, University Medical Centre, 3584CX, Utrecht / St Antonius Hospital, 3435CM, Nieuwegein, The Netherlands; h.vansantvoort{at}umcutrecht.nl

Abstract

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.

  • chronic pancreatitis
  • intractable pain
  • endoscopy
  • pancreatic surgery
  • quality of life

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

https://doi.org/10.1136/gutjnl-2020-322117

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

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    Footnotes

    • Twitter @marcbesselink

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.