Patient with Chronic Abdominal Pain from Pancreatitis

2016 ◽  
Author(s):  
Jianguo Cheng
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Imaging Techniques ◽  
Physical Symptoms ◽  
Chronic Abdominal Pain ◽  
Celiac Plexus ◽  
Comprehensive Treatment ◽  
Gastrointestinal Complications

Early diagnosis of chronic pancreatitis is possible by combining clinical information with pancreatic function testing, endoscopic ultrasonography, histology, and traditional imaging techniques such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Such an approach helps improve the sensitivity and specificity of these complementary modalities. Pain management of chronic pancreatitis involves multidisciplinary and multimodal approaches. Behavioral modifications such as alcohol cessation, nutritional optimization, and cognitive-behavioral therapy play a significant role for better long-term outcomes. Pharmacologic management is directed at relieving both psychological and physical symptoms, and combination pharmacotherapies are often needed to address pancreatic deficiency, abdominal pain, and psychological disorders. Interventional approaches to celiac plexus and splanchnic nerve blocks and denervation (radiofrequency ablation, endoscopic or surgical denervation) may provide significant and prolonged pain relief. Neuromodulation in the form of spinal cord stimulation is a viable option for long-term pain relief. Managing complications of chronic pancreatitis, such as gastrointestinal complications (peptic ulcer, bile duct stenosis), pseudocysts, malnutrition, depression, diabetes, and painful diabetic neuropathy, is an integral part of comprehensive treatment and requires close collaboration between members of a multidisciplinary team.   This review contains 1 figures, 2 tables and 64 references Key words: behavioral modifications, celiac plexus, chronic abdominal pain, chronic pancreatitis, interventional therapy, pharmacologic modulation, splanchnic nerves, surgical intervention

A pilot-study of hypnotherapy as complementary treatment for pain in chronic pancreatitis

2018 ◽  
Vol 15 (4) ◽  
Author(s):  
Jacob Juel ◽  
Randi Abrahamsen ◽  
Søren S. Olesen ◽  
Asbjørn M. Drewes
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pilot Study ◽  
Pain Relief ◽  
Social Life ◽  
Chronic Abdominal Pain ◽  
Primary Efficacy ◽  
Open Label ◽  
Efficacy Parameter ◽  
Irritable Bowel

Abstract BackgroundChronic pain is the hallmark symptom of chronic pancreatitis (CP). Its treatment is complicated, and often the patients have side-effects notwithstanding that pain is not ameliorated in many cases. Hypnotherapy has been shown to improve symptoms of irritable bowel syndrome including abdominal pain and, as such, may serve as a remedy to relive pain. The aim of this open-label pilot-study was to test the effect of hypnotherapy for pain in patients with CP. MethodsFour patients with CP and chronic abdominal pain were included and followed for four consecutive weeks. The primary efficacy parameter was pain relief. After 1 week of baseline patients received a 1-h session of hypnotherapy. This was repeated at day 15 and day 23 and supplemented by self-administered hypnotherapy. ResultsThree of four participants completed the trial and experienced short lasting pain reduction during the trial. The reported pain relief was in the range of 20%–39% compared to baseline. Hypnotherapy improved self-reported sleep, vitality, and social life. ConclusionsThe results suggest that hypnotherapy may reduce pain related to CP. Furthermore, no adverse effects were reported and the majority of participants completed the trial. Further prospective controlled trials are warranted to examine the potential of hypnotherapy.

Ultrasound-Guided Subcostal TAP Block with Depot Steroids in the Management of Chronic Abdominal Pain Secondary to Chronic Pancreatitis: A Three-Year Prospective Audit in 54 Patients

Pain Medicine ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. 118-124 ◽  
Author(s):  
Gopinath Niraj ◽  
Yehia Kamel
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
Pain Syndrome ◽  
Chronic Abdominal Pain ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane

Abstract Background Chronic pancreatitis is a common cause of recurrent chronic abdominal pain that utilizes significant health care resources. Pain in chronic pancreatitis can be of two types. Visceral pain occurs during ongoing pancreatic inflammation. Once pancreatic inflammation subsides, the pain generator can move to the abdominal wall as a result of viscerosomatic convergence and present as abdominal myofascial pain syndrome. Subcostal transversus abdominis plane block is an abdominal plane block that has been proven effective in upper abdominal pain of somatic origin. Design The authors discuss the two distinct types of chronic abdominal pain as a result of pancreatitis and present a prospective audit of a management pathway. Methods Over a three-year period, 54 patients with chronic abdominal pain as a result of pancreatitis were prospectively audited at a tertiary care university hospital. Patients were offered bilateral subcostal transversus abdominis plane block with depot steroids as the primary interventional treatment in the pathway. Results In patients with myofascial pain secondary to chronic pancreatitis, the block was effective in producing clinically significant pain relief at three months (95%, 20/21) and durable pain relief lasting six months (62%, 13/21). In patients with visceral pain, the block produced a transient benefit lasting two to three weeks in one-third (six of 17). Conclusions Subcostal transversus abdominis plane block may be an option in the management of abdominal myofascial pain syndrome secondary to chronic pancreatitis. The block is ineffective in producing clinically significant pain relief in the presence of ongoing pancreatic inflammation.

An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis

2003 ◽  
Vol 57 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Darwin L. Conwell ◽  
Gregory Zuccaro ◽  
John J. Vargo ◽  
Patricia A. Trolli ◽  
Frederick VanLente ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Chronic Abdominal Pain ◽  
Pancreatic Function ◽  
Pancreatic Function Test ◽  
Function Test

The Liverpool duodenum-and spleen-preserving near-total pancreatectomy can provide long-term pain relief in patients with end-stage chronic pancreatitis

2019 ◽  
Vol 404 (7) ◽  
pp. 831-840 ◽  
Author(s):  
A. R. G. Sheel ◽  
R. D. Baron ◽  
L. D. Dickerson ◽  
P. Ghaneh ◽  
F. Campbell ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Total Pancreatectomy ◽  
Spleen Preserving ◽  
End Stage

Missed diagnosis of imperforate hymen later presenting with hypertension

2020 ◽  
Vol 13 (9) ◽  
pp. e237416
Author(s):  
Moira Chia ◽  
Christopher Ho
Keyword(s):  
Abdominal Pain ◽  
Adolescent Girl ◽  
Chronic Abdominal Pain ◽  
Medical Attention ◽  
Imperforate Hymen ◽  
Missed Diagnosis

An adolescent girl presented with hypertension and was found to have haematocolpos and imperforate hymen. She had a background of chronic abdominal pain and had sought medical attention multiple times prior, with the diagnosis being missed as pubertal evaluation and perineal examination had been neglected during those visits. Hypertension resolved following hymenectomy and drainage of haematocolpos with no long-term sequelae.

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