Understanding chronic pancreatitis pain

What is chronic pain?

Chronic pain is ongoing and recurrent pain that lasts beyond the usual course of acute illness or injury, or more than 3-6 months. Chronic pain is different from acute pain. Acute pain is helpful because it sends our body a signal that it needs to rest or undergo some change, and is expected to resolve. Chronic pain is ongoing and does not serve a helpful function, instead, the pain itself becomes the problem. Chronic pain adversely affects the individual’s well-being. 50 million Americans experience chronic pain. 

What causes pancreatitis pain?

Chronic pancreatitis occurs when the pancreas is damaged by inflammation, irritation, or swelling over an extended period of time. This can happen for a variety of reasons, for example: genetics, gallstones, auto-immune conditions and environmental factors. Chronic pancreatitis affects people of all ages from children (pediatric pancreatitis) to adults in the US and throughout the world. 

The most common symptom of chronic pancreatitis is abdominal pain, and over 80% of patients suffer from it. We know that the pain system is incredibly complex. Research shows that chronic pain is connected to changes in the brain. Unfortunately, the pain system can stop working properly or the way it should in people with chronic pain. Also, pain systems can be faulty. For example, some people feel pancreatic pain although their pancreas has been removed during TPIAT surgery (total pancreatectomy with islet autotransplantation). 

Which factors contribute to chronic pain? 

Chronic pain can be influenced by social, psychosocial and biological factors. This is explained by a biopsychosocial understanding of pain. 

Cultural aspects, socioeconomic status, social and peer interactions, and parental and family factors all play a role in chronic pain. Pain can also be influenced by psychosocial factors like individual beliefs, coping mechanisms, mood and affect, and anxiety and fear. Biological factors can impact pain perception, which includes aspects of health or disease, pain processing, and the sex and pubertal development of the patient. 

All of the factors described above can also be influenced by different health habits such as  sleep, smoking, physical activity, health beliefs, and substance abuse. 

How does chronic pain impact patients?

How does pain affect children and adults? 

Pain can impact the lives of patients in many different ways. People can have reduced physical functioning, which means that certain activities can become difficult or impossible. Some patients have problems sleeping and fulfilling their roles in social contexts or at work. Children suffering from pain might struggle to attend school and perform well. In general, it can be challenging to function socially. Pain can also reduce the psychological functioning of patients. For example, chronic pain can cause stress, worries and anxiety. Unfortunately, depression is common among people who suffer from chronic pain.

How does pain affect family members and caregivers? 

If a child suffers from pain, it can affect parents and the whole family. Parents have their own emotional responses to the diagnosis and management of their child’s chronic pain. Many feel discouraged by the lack of clear diagnosis or a treatment plan and are angry, worried, and/or fearful about the child’s condition. 

Pancreatitis pain – assessment, treatment and management

Assessment of pancreatitis pain                                                

Chronic pain is multidimensional and difficult to assess and treat. A broad assessment is necessary in order to create comprehensive treatment. The following factors of the pain should be considered:

• Intensity/severity
• Location 
• Duration, frequency 
• Quality (neuropathic vs nociceptive) 

It is important to know how pain impacts the individual person in order to assess the pain. Since anxiety and depression are very common among chronic pain patients, relevant symptoms should be addressed.  

The pain system is complex and involves the brain. Looking at the brain can give important insights into how pain is caused and modulated. By looking at the brain, we know that adult pancreatitis patients are more sensitive to pressure pain and have impaired pain modulation.

Treatment of chronic and recurrent pain

Pain should be assessed in a comprehensive manner and treated using different approaches. These approaches involve education, pharmacological therapies, and physical therapy. Complementary and alternative therapies and psychological interventions can help. 

Psychological therapies are an important method for the management of chronic and recurrent pain in children and adolescents. 

Pain self-management 

Self-management are actions by the patient to manage or minimize the impact of a chronic condition on physical health. This also involves managing psychosocial problems that result from the condition. 

Guidelines which address optimal pain care for adults and children recommend pain self-management. It is important to build self efficacy to manage your specific symptoms and disease. It can be helpful to learn new skills and behaviors for living well with a chronic condition. These skills can include physical activity, sleep interventions and relaxations strategies. 

Pancreatitis pain – Takeaways

Pain significantly reduces quality of life for patients. It is a frequent, distressing, and impairing symptom for people suffering from chronic pancreatitis. Pain is also a complex phenomenon that requires a multi-pronged treatment approach that addresses biological, psychological, and social factors. 

Dr. Tonya Palermo is a Psychologist and Professor of Anesthesiology and Pain Medicine at the University of Washington. She is also an Associate Director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute.

This article is based on our webinar “Living with Chronic Pain and Pancreatitis: Advances in Assessment and Treatment” with Dr. Tonya Palermo. You can watch the recording here.