Outpatient Pain Management in Children With Chronic Pancreatitis: A Scoping Systematic Review

Best Practices for Chronic Pancreatitis Pain Management: A Comprehensive Evidence-Based Review

Purpose

This study aimed to identify and synthesize high-quality evidence regarding pain management in individuals with chronic pancreatitis (CP) to serve as a reference for clinical practice interventions.

Methods

A thorough review encompassing databases, clinical guidelines, and information platforms, such as UpToDate, Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), guide.medlive.cn, PubMed, Embase, Chinese Biomedical Literature Service System, China National Knowledge Infrastructure (CNKI), and Wanfang Data, was conducted to gather relevant evidence on pain management in CP. The search encompassed clinical decisions, evidence summaries, guidelines, systematic reviews, and expert consensus documents published up to October 2023. Two researchers independently evaluated included articles and extracted data pertinent to clinical practice.

Results

In total, 21 articles met the inclusion criteria for final analysis, comprising four guidelines, two expert consensus documents, one clinical decision, and 14 systematic reviews. The evidence was categorized into seven key treatment domains: pain evaluation, drug intervention, endoscopic treatment, surgical intervention, Traditional Chinese Medicine (TCM) therapies, other treatment modalities, and approaches tailored to specific populations. 19 individual recommendations were derived from these categories.

Conclusion

This review consolidates the best available evidence for pain management in CP. However, in clinical application, the optimal intervention should be individualized, taking into account patient preferences, the healthcare institution's technical capabilities, and other relevant factors. This approach is crucial for optimizing pain management and enhancing the quality of life in individuals with CP.

Effectiveness of the clinical nursing pathway model in nursing mild acute pancreatitis: A retrospective study

This study aimed to evaluate the effectiveness of the clinical nursing pathway model in the care of patients with mild acute pancreatitis (MAP). We conducted a retrospective analysis of medical records for 80 patients diagnosed with MAP at our hospital between September 2021 and March 2023. The patients were randomly assigned to 2 groups: the control group, which received routine nursing care, and the observation group, which followed the clinical nursing pathway. The primary outcomes assessed were the time to symptom relief, recovery time from gastrointestinal bloating, emotional status, blood biochemical indicators, self-efficacy, self-care ability, and quality of life. The observation group experienced significantly shorter times for the resolution of abdominal pain and bloating, normalization of serum/urine amylase levels, and anal exhaust compared to the control group (P < .05). Additionally, the observation group reported lower scores on the self-rating anxiety scale and self-rating depression scale, and higher scores on the General Self-Efficacy Scale (P < .05). Biochemical analysis revealed that the levels of serum amylase, lipase, and C-reactive protein were significantly lower in the observation group (P < .05). Moreover, the observation group showed significantly higher scores for self-care ability and overall quality of life compared to the control group (P < .05). The clinical nursing pathway model significantly enhances the quality of care for patients with MAP by accelerating symptom relief, improving emotional status, reducing biochemical markers, and enhancing quality of life. This model effectively promotes both physical and mental health, increases self-care ability, and offers substantial potential for broader application in clinical practice.

Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE

INTRODUCTION

Among children who suffer from acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), acute pancreatitis (AP) episodes are painful, often require hospitalization, and contribute to disease complications and progression. Despite this recognition, there are currently no interventions to prevent AP episodes. In this retrospective cohort study, we assessed the impact of pancreatic enzyme therapy (PERT) use on clinical outcomes among children with pancreatic-sufficient ARP or CP.

METHODS

Children with pancreatic-sufficient ARP or CP in the INSPPIRE-2 cohort were included. Clinical outcomes were compared for those receiving vs not receiving PERT, as well as frequency of AP before and after PERT. Logistic regression was used to study the association between development of AP episodes after starting PERT and response predictors.

RESULTS

Among 356 pancreatic-sufficient participants, 270 (76%) had ARP, and 60 (17%) received PERT. Among those on PERT, 42% did not have a subsequent AP episode, during a mean 2.1 years of follow-up. Children with a SPINK1 mutation ( P = 0.005) and those with ARP (compared with CP, P = 0.008) were less likely to have an AP episode after starting PERT. After initiation of PERT, the mean AP annual incidence rate decreased from 3.14 down to 0.71 ( P < 0.001).

DISCUSSION

In a retrospective analysis, use of PERT was associated with a reduction in the incidence rate of AP among children with pancreatic-sufficient ARP or CP. These results support the need for a clinical trial to evaluate the efficacy of PERT to improve clinical outcomes among children with ARP or CP.

Pain in chronic pancreatitis: What can we do today?

The aim of this study is to illustrate the complexity of pain management in chronic pancreatitis (CP). In this context, pain represents the most common and debilitating symptom, and it deeply affects patient's quality of life. Multiple rating scales (unidimensional, bidimensional and multidimensional) have been proposed to quantify CP pain. However, it represents the result of complex mechanisms, involving genetic, neuropathic and neurogenic factors. Considering all these aspects, the treatment should be discussed in a multidisciplinary setting and it should be approached in a stepwise manner. First, a lifestyle change is recommended and nonsteroidal anti-inflammatory drugs represent the gold standard among medical treatments for CP patients. The second step, after medical approach, is endoscopic therapy, especially for complicated CP. In case of failure, tailored surgery represents the third step and decompressive or resection procedures can be chosen. In conclusion, CP pain's management is challenging considering all these complex aspects and the lack of international protocols.

Interventions for Pancreatitis-New Approaches, Knowledge Gaps, and Research Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop

ABSTRACT

There exists no cure for acute, recurrent acute or chronic pancreatitis and treatments to date have been focused on managing symptoms. A recent workshop held by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) focused on interventions that might disrupt or perhaps even reverse the natural course of this heterogenous disease, aiming to identify knowledge gaps and research opportunities that might inform future funding initiatives for NIDDK. The breadth and variety of identified active or planned clinical trials traverses the spectrum of the disease and was conceptually grouped for the workshop into behavioral, nutritional, pharmacologic and biologic, and mechanical interventions. Cognitive and other behavioral therapies are proven interventions for pain and addiction, but barriers exist to their use. Whilst a disease specific instrument quantifying pain is now validated, an equivalent is lacking for nutrition - and both face challenges in ease and frequency of administration. Multiple pharmacologic agents hold promise. Ongoing development of Patient Reported Outcome (PRO) measurements can satisfy Investigative New Drug (IND) regulatory assessments. Despite multiple randomized clinical trials demonstrating benefit, great uncertainty remains regarding patient selection, timing of intervention, and type of mechanical intervention (endoscopic versus surgery). Challenges and opportunities to establish beneficial interventions for patients were identified.