Assessment of pain associated with chronic pancreatitis: An international consensus guideline

A.M. Drewes*, C.L.V. Veldhuisen, M.D. Bellin, M.G. Besselink, S.A. Bouwense, S.S. Olesen, H. van Santvoort, L. Vase, J.A. Windsor

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Pain is the most common symptom in chronic pancreatitis (CP) with a major impact on quality of life. Few validated questionnaires to assess pain in CP exist, and the lack of consensus negatively impacts clinical management, research and meta-analysis. This guideline aims to review generic pain questionnaires for their usability in CP, to outline how pain assessment can be modified by confounding factors and pain types, to assess the value of additional measures such as quality of life, mental health and quantitative sensory testing, and finally to review pain assessment questionnaires used specifically in CP. A systematic review was done to answer 27 questions that followed the PICO (Population; Intervention; Comparator; Outcome) template. Quality of evidence of the statements was judged by Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria. The manuscript was sent for review to 36 experts from various disciplines and continents in a multi-stage Delphi process, and finally reviewed by patient representatives. Main findings were that generic pain instruments are valid in most settings, but aspects of pain are specific for CP (including in children), and instruments have to account for the wide phenotypic variability and development of sensitization of the central nervous system. Side effects to treatment and placebo effects shall also be considered. Some multidimensional questionnaires are validated for CP and are recommended together with assessment of quality of life and psychiatric co-morbidities. This guideline will result in more homogeneous and comprehensive pain assessment to potentially improve management of painful CP. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Original languageEnglish
Pages (from-to)1256-1284
Number of pages29
JournalPancreatology
Volume21
Issue number7
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • Pain
  • Assessment
  • Chronic pancreatitis
  • Patient reported outcome
  • Quantitative sensory testing
  • Children
  • Neural sensitization
  • Placebo
  • Side effects
  • QUALITY-OF-LIFE
  • ALCOHOLIC CHRONIC-PANCREATITIS
  • PYLORUS-PRESERVING WHIPPLE
  • TERM-FOLLOW-UP
  • CLINICAL-TRIALS
  • LONG-TERM
  • TOTAL PANCREATECTOMY
  • ISLET AUTOTRANSPLANTATION
  • CENTRAL SENSITIZATION
  • HEAD RESECTION

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