Altered central pain processing after pancreatic surgery for chronic pancreatitis

SA Bouwense, UA Ali, RP ten Broek, Y Issa, Casper van Eijck, OH Wilder-Smith, H van Goor

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47 Citations (Scopus)

Abstract

BackgroundChronic abdominal pain is common in chronic pancreatitis (CP) and may involve altered central pain processing. This study evaluated the relationship between pain processing and pain outcome after pancreatic duct decompression and/or pancreatic resection in patients with CP. MethodsPatients with CP underwent quantitative sensory testing. Pain processing was measured via electrical pain detection (ePDT) and electrical pain tolerance (ePTT) thresholds in dermatomes C5 and L4. Inhibitory descending pain control mechanisms were assessed using the conditioned pain modulation (CPM) paradigm. Healthy controls and patients with CP were compared, and patients with CP and a poor pain outcome (visual analogue scale (VAS) score greater than 30) were compared with those with a g ResultsForty-eight patients with CP had lower ePDT, ePTT and CPM responses compared with values in 15 healthy controls (P<0<bold>030</bold>). The sum of ePDT values was lower in patients with a poor pain outcome than in those with a good outcome (median 7<bold>1</bold> versus 11<bold>2</bold>mA; P=0<bold>008</bold>). There was a correlation with the VAS score and the sum of ePDT values (r(s)=-0<bold>45</bold>, P=0<bold>016</bold>) and ePTT values (r(s)=-0<bold>46</bold>, P=0<bold>011</bold>), an ConclusionAfter pain-relieving pancreatic surgery, patients with CP exhibit altered central pain processing compared with that in healthy controls. Poor pain outcomes are associated with more central sensitization and more pronociceptive descending pain modulation, and this should be considered when managing persistent pain after pain-relieving surgery for CP. Presented in part to the 7th Alpine Liver and Pancreatic Surgery Meeting, Madonna di Campiglio, Italy, January 2012, and the American Pan New approach to pain control
Original languageUndefined/Unknown
Pages (from-to)1797-1804
Number of pages8
JournalBritish Journal of Surgery
Volume100
Issue number13
DOIs
Publication statusPublished - 2013

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