Pain Experience in Pancreatitis: Strong Association of Genetic Risk Loci for Anxiety and PTSD in Patients With Severe, Constant, and Constant-Severe Pain

Recent advances in the understanding and management of chronic pancreatitis pain

Abdominal pain is the most common symptom of chronic pancreatitis (CP) and is often debilitating for patients and very difficult to treat. To date, there exists no cure for the disease. Treatment strategies focus on symptom management and on mitigation of disease progression by reducing toxin exposure and avoiding recurrent inflammatory events. Traditional treatment protocols start with medical management followed by consideration of procedural or surgical intervention on selected patients with severe and persistent pain. The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders, exocrine pancreatic insufficiency, mineral bone disease, frailty, and malnutrition, are in its early stages. Recent clinical studies and animal models have been designed to improve investigation into the pathophysiology of CP pain, as well as to improve pain management. Despite the array of tools available, many therapeutic options for the management of CP pain provide incomplete relief. There still remains much to discover about the neural regulation of pancreas-related pain. In this review, we will discuss research from the last 5 years that has provided new insights into novel methods of pain phenotyping and the pathophysiology of CP pain. These discoveries have led to improvements in patient selection for optimization of outcomes for both medical and procedural management, and identification of potential future therapies.

The effect of anxiety and depression on the health-related quality of life of severe acute pancreatitis survivors: structural equation modeling approach

Background

Understanding the relationship between anxiety, depression and health-related quality of life (HRQOL) provides important clues to alleviate anxiety, depression and improve HRQOL in patients after severe acute pancreatitis (SAP). The aim of this study was to examine the effects of anxiety and depression on HRQOL in post-SAP patients using structural equation modeling.

Methods

A cross-sectional study design was used and 134 patients with SAP from the Affiliated Hospital of Zunyi Medical University were recruited. Data collected included demographic and clinical characteristics, the English Standard Short Form 36 (SF-36) Health Survey, The Self-rating Anxiety Scale (SAS) and The Self-rating Depression Scale (SDS). Structural equation modeling analysis was conducted using the AMOS 24.0 program.

Results

The mean of HRQOL score was 49.42 (SD = 23.01). The prevalence of anxiety and depression in post-SAP patients was 33.6 and 34.3%, respectively. Both anxiety and depression have a direct negative impact on HRQOL (β = -0.360, p < 0.001; β = -0.202, p = 0.034). Anxiety also negatively affects HRQOL indirectly through depression (β = -0.118, p = 0.043). The analysis of the covariance structure revealed that the resulting model had a reasonable goodness of fit.

Conclusion

Anxiety and depression reduce the quality of life of SAP patients during recovery. Regular assessment and management of the anxiety and depression status of SAP patients is necessary and will help them improve their HRQOL more effectively.

Psychiatric Disease Susceptibility and Pain in Chronic Pancreatitis: Association or Causation?

Pain perception in chronic pancreatitis (CP) is governed by the transmission of nociceptive inputs into the pain processing centers of the brain. These regions of the brain overlap with those that regulate and process emotions and cognition. Disorders in these regions also result in psychiatric conditions such as depression, anxiety, and posttraumatic stress disorder. The present study by Dunbar et al. evaluated 24 single nucleotide polymorphisms associated with anxiety and/or posttraumatic stress disorder and found correlations with constant and severe pain phenotypes in CP patients from a large cross-sectional cohort study. Although causation cannot be proven, the findings suggest that there may be a role for neuromodulator drugs for the treatment of pain in CP based on individual genetic susceptibility.