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Pain is a predominant feature in up to 90% of patients with alcohol-induced pancreatitis and in up to 50% of patients with other types of CP. Pain associated with acute pancreatitis initially is typically limited to the duration of the individual episode. Some people though may experience chronic abdominal pain following recurrent episodes of acute pancreatitis with the progression to chronic pancreatitis. The pain of chronic pancreatitis is characterized in several ways, including:

• Worsens with eating or drinking
• May be relieved by sitting upright or leaning forward
• Described as "penetrating" and radiating to the back or as a continuous dull abdominal pain

What causes the intense pain in chronic pancreatitis? For each individual, there may be a variety of factors leading to the intensity and duration of pain. Pain may result from various sources including:

• Increased pressure in the pancreatic duct (hypertension) due to the continued secretion of pancreatic enzymes despite the presence of an obstruction in the duct
• Pressure on tissue around the distended or hypertensive duct and its branches
• Single or multiple strictures and/or calculi
• Pancreatic fibrosis and inflammation may cause bile duct or duodenal stenosis
• Pancreatic fibrosis which forms scar tissue that leads to increased pressure
• Pancreatic ischemia (decreased blood flow due to increased tissue pressure)

• Researchers have identified changes that occur to the nerves innervating the pancreas, including:

  • nerve growth - increased number and diameter of pancreatic nerves has been demonstrated
  • damage to the pancreatic nerves
  • large axonal trunks (the long part of a nerve cell that transmits impulses) in the pancreatic head and possible axonal degeneration in other areas
  • an increase in eosinophils, a type of white blood cell that increases with infection and allergy
  • a direct relationship between the nerve cells and inflammatory cells in CP (neuroimmune interaction theory) which may be an additional source of pain. The degree of infiltration of immune cells into the nerves in the pancreas correlates positively with the intensity of pain.

The investigation of nerve damage in the pancreas (neuropathy) and the relationship between nerve cells and inflammatory or immune cells are developments that researchers are studying that may help to better understand the source of pain in chronic pancreatitis.

For further information about the relationship between pain and pancreatitis, please click on the following link: http://www.medifocus.com/abstracts.php?gid=GS007&ID=18206811

In addition to the intense physical discomfort caused by pain in patients with chronic pancreatitis, pain has a significant impact on the emotional and mental dimensions of the patients. Intense pain of CP strongly impacts the quality of life of patients as it leads to problems with:

• Depression
• Addiction to pain relievers (opiates)
• Unemployment since patient may not be able to hold a job
• Social isolation

This aspect of chronic pancreatitis must be seriously considered in the diagnostic workup and treatment protocol for any CP patient experiencing pain.