Pancreatic and Biliary Disease Pain Management

Chronic pancreatitis and pancreatic cancer both can cause a great deal of pain, though the severity varies widely. The primary goal of both surgical and non-surgical procedures for chronic pancreatitis and cancer is to relieve the patients' pain. This includes removing or crushing stones in the pancreaticobiliary ducts (ESWL), draining bile from areas blocked by tumors or pseudocysts through ERCP, and removing the gallbladder through laparoscopic cholecystectomy, among others. Patients with sphincter of Oddi dysfunction may be candidates for endoscopic sphincterotomy of the pancreatic duct and short-term stenting.

Finding the source of pain in chronic pancreatitis is not always easy. Some believe pain develops because the growing pressure on the pancreas reduces the flow of blood to it. That pressure often comes from blocks in the pancreatic duct and scarring in the gland. Pain may also be from inflammation of the pancreatic nerves. Some patients respond well to low-dose tricyclic antidepressants, which suppress the nervous system's reaction to inflammation and pressure. Some medical centers are experimenting with nerve blocks administered with endoscopic ultrasound.

The Pain Center at Cedars-Sinai provides additional specialist services for managing pain.

Pancreatitis due to alcohol abuse may be relieved by not drinking. Pancreatic digestive enzyme supplements have been used to treat pain, though there are no definitive studies that confirm its effectiveness. In cases where pain is mild or intermittent, sometimes over-the-counter or prescription pain relievers are all that's needed.

Pancreatic cancer pain, on the other hand, can be resistant to treatment. The Interventional Pain Management Programs at the Cedars-Sinai Pain Center may provide some alternatives through some its advanced pain therapies. The center offers the full spectrum of pain management.