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A 35-Year-Old Man with Chronic Abdominal Pain (Chronic Pancreatitis)

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Practical Chronic Pain Management

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Abstract

Chronic pancreatitis (CP) is a debilitating disease with incidence of between 50 and 75 per 100,000 patients per year. Patients can present with vague symptoms typically consisting of chronic abdominal pain with radiation to the back, weight loss, dyspepsia, or new onset diabetes. These symptoms in the setting of alcohol and/or tobacco abuse should heighten a physician’s suspicion for chronic pancreatitis. Diagnosis can be difficult to make based on labs alone, and clinicians should rely on imaging modalities including computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasound (EUS), which all have high sensitivity and specificity. Management of CP can be challenging as patients usually have a prolonged course of symptoms that can span up to several years. An initial multimodal approach consisting of non-opioids, antioxidants, and central-acting neuropathic medications can be sufficient in managing abdominal pain for some patients. However, approximately 50% of patients will need an endoscopic procedure, interventional pain procedure, and/or surgery at some point in their disease course. Interventional pain procedures, including celiac plexus and splanchnic blocks, can provide extended relief in some patients. The surgical intervention most commonly performed is a lateral pancreaticojejunostomy, which has been shown to provide relief in greater than half of patients. Newer procedures that are on the horizon consist of coupling total pancreatectomy and islet auto-transplant.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Northshore University, Evanston, IL, USA

    Sumit Jain

  2. Department of Anesthesia, University of Chicago, Chicago, IL, USA

    Dalia H. Elmofty

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  1. Sumit Jain
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  2. Dalia H. Elmofty
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Correspondence to Dalia H. Elmofty .

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Editors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA

    Tariq Malik

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Jain, S., Elmofty, D.H. (2020). A 35-Year-Old Man with Chronic Abdominal Pain (Chronic Pancreatitis). In: Malik, T. (eds) Practical Chronic Pain Management. Springer, Cham. https://doi.org/10.1007/978-3-030-46675-6_23

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  • DOI: https://doi.org/10.1007/978-3-030-46675-6_23

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