Is Altered Central Pain Processing Related to Disease Stage in Chronic Pancreatitis Patients with Pain? An Exploratory Study

Stefan A W Bouwense,Søren S Olesen,Jens B Frøkjær,Harry Van Goor,Asbjørn M Drewes,Oliver H G Wilder-Smith,Steve Milanese

doi:10.1371/journal.pone.0055460

Abstract

BackgroundThe most dominant feature in chronic pancreatitis is intense abdominal pain. Changes in spinal and/or supraspinal central nervous system pain processing due to visceral nociceptive input play an important role in this pain. How altered pain processing is related to disease stage still needs study.Methodology/Principal FindingsSixty chronic pancreatitis patients were compared to 15 healthy controls. Two subgroups of pancreatitis patients were defined based on the M-ANNHEIM severity index of chronic pancreatitis; i.e. moderate and severe. Pain detection and tolerance thresholds for pressure and electric stimuli were measured in six selected dermatomes (C5, T4, T10, L1, L4 and T10BACK). In addition, the conditioned pain modulation response to cold pressor task was determined. These measures were compared between the healthy controls and chronic pancreatitis patients. Severe pancreatitis patients showed lower pain thresholds than moderate pancreatitis patients or healthy volunteers. Healthy controls showed a significantly larger conditioned pain modulation response compared to all chronic pancreatitis patients taken together.Conclusions/SignificanceThe present study confirms that chronic pancreatitis patients show signs of altered central processing of nociception compared to healthy controls. The study further suggests that these changes, i.e. central sensitization, may be influenced by disease stage. These findings underline the need to take altered central pain processing into account when managing the pain of chronic pancreatitis.

Highlights

Intense upper abdominal pain is common in chronic pancreatitis patients and is the most important predictor of health-related quality of life. [1,2] The etiology of pain remains to be elucidated and no generally accepted guidelines exist for its treatment
Conclusions/Significance: The present study confirms that chronic pancreatitis patients show signs of altered central processing of nociception compared to healthy controls
The study further suggests that these changes, i.e. central sensitization, may be influenced by disease stage. These findings underline the need to take altered central pain processing into account when managing the pain of chronic pancreatitis

Summary

Introduction

Intense upper abdominal pain is common in chronic pancreatitis patients and is the most important predictor of health-related quality of life. [1,2] The etiology of pain remains to be elucidated and no generally accepted guidelines exist for its treatment. Intense upper abdominal pain is common in chronic pancreatitis patients and is the most important predictor of health-related quality of life. [6] new treatment regimes for the debilitating pain of chronic pancreatitis are still needed. [7,8] centrally acting agents i.e. gabapentinoids or tricyclic antidepressants are not yet an accepted part of pain treatment in chronic pancreatitis. Answering questions like ‘‘How do chronic pancreatitis patients process pain and how does altered pain processing relate to their pain experience?’’ is fundamental for the design of new therapeutic strategies. Changes in spinal and/or supraspinal central nervous system pain processing due to visceral nociceptive input play an important role in this pain. How altered pain processing is related to disease stage still needs study

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