Skip to main content

Advertisement

SpringerLink
Log in

Tools for Bedsite Pain Assessments in Chronic Pancreatitis

  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic pancreatitis (CP), a condition marked by severe pain, necessitates precise pain assessment for effective treatment. This review explores recent advances in CP pain assessment, including CP-specific tools, quantitative sensory testing (QST), and the emerging use of wearable devices.

Recent Findings

Unidimensional pain assessment tools are constrained in capturing the multifaceted nature of CP pain. CP-specific tools, such as the Comprehensive Pain Assessment Tool (COMPAT) and its briefer variant, COMPAT-SF, exhibit promise but may necessitate further validation for broader adoption. QST provides a semi-objective method for characterizing pain profiles, and the P-QST consortium is refining QST for CP patients.

Additionally, technology is opening new avenues for objective pain assessment. Wearable devices, like smartwatches, can monitor vital signs, activity levels, and sleep quality. While they hold promise for improving pain assessment, their effectiveness requires further validation.

Summary

Accurate pain assessment is critical for managing CP. Recent developments include tools like COMPAT and COMPAT-SF, QST for characterizing pain profiles, and the potential of wearable devices. These advances can potentially enhance pain assessment and guide personalized treatment strategies. Integration into clinical practice and rigorous validation will be instrumental in improving CP pain assessment and raising the level of patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mullady DK, Yadav D, Amann ST, O’Connell MR, Barmada MM, Elta GH, et al. Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Gut. 2011;60:77–84.

    Article  PubMed  Google Scholar 

  2. Olesen SS, Juel J, Nielsen AK, Frøkjær JB, Wilder-Smith OHG, Drewes AM. Pain severity reduces life quality in chronic pancreatitis: implications for design of future outcome trials. Pancreatology. 2014;14:497–502.

    Article  PubMed  Google Scholar 

  3. Kuhlmann L, Olesen SS, Olesen AE, Arendt-Nielsen L, Drewes AM. Mechanism-based pain management in chronic pancreatitis – is it time for a paradigm shift? Expert Rev Clin Pharmacol. 2019;12:1–10.

    Article  Google Scholar 

  4. Poulsen JL, Olesen SS, Malver LP, Frøkjær JB, Drewes AM. Pain and chronic pancreatitis: a complex interplay of multiple mechanisms. World J Gastroenterol. 2013;19:7282–91.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161:1976–82. 

  6. Teo K, Johnson MH, Truter S, Pandanaboyana S, Windsor JA. Pain assessment in chronic pancreatitis: a comparative review of methods. Pancreatology. 2016;16:931–9.

    Article  CAS  PubMed  Google Scholar 

  7. •• Kuhlmann L, Teo K, Olesen SS, Phillips AE, Faghih M, Tuck N, et al. Development of the comprehensive pain assessment tool short form for chronic pancreatitis: validity and reliability testing. Clin Gastroenterol Hepatol [Internet]. 2022 [cited 2021 Oct 3];20:e770–83. Available from: https://pubmed.ncbi.nlm.nih.gov/34089847/. Accessed 30 Sept 2023. (This article addresses the validation of the first pancreas-specific pain assessment questionnaire and provides the possibility of thoroughly evaluating pain in CP using a questionnaire.)

  8. Teo K, Johnson MH, Drewes AM, Windsor JA. A comprehensive pain assessment tool (COMPAT) for chronic pancreatitis: development, face validation and pilot evaluation. Pancreatology. 2017;17:706–19.

    Article  CAS  PubMed  Google Scholar 

  9. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Breivik Hals EK, et al. Assessment of pain. Br J Anaesth.  2008;101:17–24.

  10. Kuhlmann L, Olesen SS, Drewes AM. Assessment of visceral pain with special reference to chronic pancreatitis. Front Pain Res. 2022;3:214.

    Article  Google Scholar 

  11. Kaiser U, Kopkow C, Deckert S, Neustadt K, Jacobi L, Cameron P, et al. Developing a core outcome domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome domains. Pain [Internet]. 2018 [cited 2021 Jan 1];159:673–83. Available from: https://www.painjournalonline.com673. Accessed 30 Sept 2023.

  12. Smith SM, Dworkin RH, Turk DC, Baron R, Polydefkis M, Tracey I, et al. The Potential Role of Sensory Testing, Skin Biopsy, and Functional Brain Imaging as Biomarkers in Chronic Pain Clinical Trials: IMMPACT Considerations. J Pain [Internet]. 2017 [cited 2022 Oct 8];18:757–77. Available from: https://www.jpain.organdwww.sciencedirect.com

  13. Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch CE. Quality of life in chronic pancreatitis, results after duodenum-preserving resection of the head of the pancreas. Pancreas. 1995;11:77–85.

    Article  CAS  PubMed  Google Scholar 

  14. Patel KV, Amtmann D, Jensen MP, Smith SM, Veasley C, Turk DC. Clinical outcome assessment in clinical trials of chronic pain treatments. Pain Rep [Internet]. 2021;6:e784. https://doi.org/10.1097/PR9.0000000000000784. [cited 2023 Aug 29].

    Article  PubMed  Google Scholar 

  15. Terhorst Y, Messner EM, Schultchen D, Paganini S, Portenhauser A, Eder AS, et al. Systematic evaluation of content and quality of English and German pain apps in European app stores. Internet Interv [Internet]. 2021;24:100376. https://doi.org/10.1016/j.invent.2021.100376.

    Article  PubMed  Google Scholar 

  16. •• Drewes AM, Bellin MD, Besselink MG, Bouwense SA, Olesen SS, van Santvoort H, et al. Assessment of pain associated with chronic pancreatitis: an international consensus guideline. Pancreatology. 2021;21:1256–84. (This article presents an international consensus and guideline on how to assess pain in chronic pancreatitis. This reference is key knowledge when trying to improve pain assessment in CP.)

    Article  PubMed  Google Scholar 

  17. Kumar P, Tripathi L. Challenges in pain assessment: pain intensity scales. Indian J Pain. 2014;28:61.

    Article  Google Scholar 

  18. Morley S. Bias and reliability in pain ratings. Pain. 2016;157:993–4.

    Article  PubMed  Google Scholar 

  19. Hadjistavropoulos T, Craig KD. A theoretical framework for understanding self-report and observational measures of pain: a communications model. Behav Res Ther [Internet]. 2002 [cited 2023 Aug 29];40:551–70. Available from: https://www.elsevier.com/locate/brat. Accessed 30 Sept 2023.

  20. Robinson ME, Myers CD, Sadler IJ, Riley JL, Kvaal SA, Geisser ME. Bias effects in three common self-report pain assessment measures. Clin J Pain. 1997;13:74–81.

    Article  CAS  PubMed  Google Scholar 

  21. Palsson TS, Christensen SWM, De Martino E, Graven-Nielsen T. Pain and disability in low back pain can be reduced despite no significant improvements in mechanistic pain biomarkers. Clin J Pain. 2021;37:330–8.

    Article  PubMed  Google Scholar 

  22. Yadav D, Palermo TM, Phillips AE, Bellin MD, Conwell DL. Painful chronic pancreatitis - new approaches for evaluation and management. Curr Opin Gastroenterol. 2021;37:504–11.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nijs J, George SZ, Clauw DJ, Fernández-de-las-Peñas C, Kosek E, Ickmans K, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021;3:e383–92.

    Article  CAS  PubMed  Google Scholar 

  24. • Phillips AE, Faghih M, Singh VK, Olesen SS, Kuhlmann L, Novovic S, et al. Rationale for and development of the pancreatic quantitative sensory testing consortium to study pain in chronic pancreatitis. Pancreas [Internet]. 2021 [cited 2022 Apr 22];50:1298–304. Available from: https://journals.lww.com/pancreasjournal/Fulltext/2021/10000/Rationale_for_and_Development_of_the_Pancreatic.10.aspx. Accessed 30 Sept 2023. (This article marks the beginning of using QST as a pain assessment tool in clinical studies for CP patients.)

  25. •• Phillips AE, Faghih M, Kuhlmann L, Larsen IM, Drewes AM, Singh VK, et al. A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis: pain phenotyping in chronic pancreatitis. Pancreatology. 2020;20:25–34. (The P-QST consortium presents the bedside QST regimen that can be used to evaluate pain profiles in CP.)

    Article  PubMed  Google Scholar 

  26. Smith SM, Dworkin RH, Turk DC, Baron R, Polydefkis M, Tracey I, et al. The potential role of sensory testing, skin biopsy, and functional brain imaging as biomarkers in chronic pain clinical trials: IMMPACT considerations. J Pain. 2017;18:757–77.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Linde LD, Duarte FCK, Esmaeili H, Hamad A, Masani K, Kumbhare DA. The nociceptive flexion reflex: a scoping review and proposed standardized methodology for acquisition in those affected by chronic pain. Br J Pain. 2021;15:102–13.

    Article  PubMed  Google Scholar 

  28. May ES, Gií Avila C, Dinh ST, Heitmann H, Hohn VD, Nickel MM, et al. Dynamics of brain function in patients with chronic pain assessed by microstate analysis of resting-state electroencephalography. Pain [Internet]. 2021;162:2894–908. https://doi.org/10.1097/j.pain.0000000000002281. [cited 2023 Aug 30].

    Article  PubMed  PubMed Central  Google Scholar 

  29. Morton DL, Sandhu JS, Jones AK. Brain imaging of pain: state of the art. J Pain Res [Internet]. 2016 [cited 2023 Aug 30];9:613–24. Available from: https://www.tandfonline.com/action/journalInformation?journalCode=djpr20http://creativecommons.org/licenses/by/4.0/.Thelicensepermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalauthorandsourcearecredited. Accessed 30 Sept 2023.

  30. Lelic D, Olesen SS, Graversen C, Brock C, Valeriani M, Drewes AM, et al. Electrophysiology as a tool to unravel the origin of pancreatic pain. World J Gastrointest Pathophysiol [Internet]. 2014;5:33–9. https://doi.org/10.4291/wjgp.v5.i1.33. [cited 2023 Aug 30].

    Article  PubMed  Google Scholar 

  31. Zebhauser PT, Hohn VD, Ploner M. Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain [Internet]. 2023;164:1200–21. https://doi.org/10.1097/j.pain.0000000000002825. ([cited 2023 Aug 30]).

    Article  PubMed  Google Scholar 

  32. Liao D, Nedergaard RB, Unnisa M, Mahapatra SJ, Faghih M, Phillips AE, Yadav D, Singh VK, Olesen SS, Talukdar R, et al. Electrocardiography assessment of sympatico–vagal balance during resting and pain using the texas instruments ADS1299. Bioengineering 2023;10:205. https://doi.org/10.3390/bioengineering10020205

  33. • Leroux A, Rzasa-Lynn R, Crainiceanu C, Sharma T. Wearable devices: current status and opportunities in pain assessment and management. Digit Biomark. 2021;5:89–102. (These articles present the possible future in pain assessment, including in CP. The validity in CP, however, remains to be examined.)

    Article  PubMed  PubMed Central  Google Scholar 

  34. • Hadjiat Y, Arendt-Nielsen L. Digital health in pain assessment, diagnosis, and management: overview and perspectives. Front Pain Res. 2023;4:1097379. https://doi.org/10.3389/fpain.2023.1097379(These articles present the possible future in pain assessment, including in CP. The validity in CP, however, remains to be examined.)

  35. Bjelland I, Dahl AA, Haug T, Neckelmann D. The validity of the hospital anxiety and depression scale an updated literature review. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  36. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–65.

    Article  CAS  PubMed  Google Scholar 

  37. Lee PH, Macfarlane DJ, Lam T, Stewart SM. Validity of the international physical activity questionnaire short form. Int J Behav Nutr Phys Act. 2011;8:1–11.

    Google Scholar 

  38. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L. The pain catastrophizing scale: further psychometric evaluation with adult samples. J Behav Med. 2000;23:351–65.

    Article  CAS  PubMed  Google Scholar 

  39. Fayers P, Bottomley A. Quality of life research within the EORTC - the EORTC QLQ-C30. Eur J Cancer. 2002;38:125–33.

    Article  Google Scholar 

  40. Bishop A. Pain Attitudes and Beliefs Scale ( PABS ) The illness perceptions questionnaire-revised ( IPQ-R ). J Physiother. 2010;56:279–80.

    Article  PubMed  Google Scholar 

  41. Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30:191–7.

    Article  PubMed  Google Scholar 

  42. Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int. 1985;5:145–8.

    Article  CAS  PubMed  Google Scholar 

  43. Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract [Internet]. 2003 [cited 2022 Oct 1];3:310–6. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1530-7085.2003.03034.x

  44. Reid GJ, Gilbert CA, Mcgrath PJ. The pain coping questionnaire: preliminary validation. Pain. 1998;76:83–96.

    Article  CAS  PubMed  Google Scholar 

  45. Goñi E, Madariaga JM, Axpe I, Goñi A. Structure of the personal self-concept ( PSC ). Int J Psychol Psychol Ther. 2011;11:509–22.

    Google Scholar 

  46. Carpenter JS, Andrykowski MA. Psychometric evaluation of the Pittsburgh sleep quality index. J Psychosom Res. 1998;45:5–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej 4, 4. Sal, 9000, Aalborg, Denmark

    Louise Kuhlmann MD, PhD & Asbjørn Mohr Drewes MD, PhD, DMSc

  2. Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark

    Louise Kuhlmann MD, PhD

  3. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Asbjørn Mohr Drewes MD, PhD, DMSc

Authors
  1. Louise Kuhlmann MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Asbjørn Mohr Drewes MD, PhD, DMSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LK prepared the manuscript and Fig. 1 after thorough discussions with AMD on the context and setup. AMD reviewed and commented on the manuscript.

Corresponding author

Correspondence to Louise Kuhlmann MD, PhD.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflict of Interest

Louise Kuhlmann declares that she has no conflict of interest. Asbjørn Mohr Drewes declares that he has no conflict of interest,

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuhlmann, L., Drewes, A.M. Tools for Bedsite Pain Assessments in Chronic Pancreatitis. Curr Treat Options Gastro 22, 78–86 (2024). https://doi.org/10.1007/s11938-024-00445-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-024-00445-5

Keywords

Search

Navigation