TY - JOUR
AU - Machicado, Jorge D.
AB - Purpose of ReviewTraditional pain management of painful chronic pancreatitis (CP) follows a trial-and-error approach, often leading to long-term opioids and ineffective interventions. A precision medicine approach, tailoring treatment based on pain mechanisms, may allow a more targeted and rational use of interventions for painful CP. This review provides clinical pearls on how to diagnose each pain mechanism and presents a framework for mechanism-based management of CP.Recent FindingsPain from CP can be caused by nociceptive, neuropathic, and/or nociplastic mechanisms. These pain mechanisms are not mutually exclusive and can co-exist within the same individual. The mechanisms leading to pain on an individual patient can be determined using a combination of medical history, survey instruments, abdominal imaging, response to different therapies, quantitative sensory testing, neuroimaging, and complex genetics. Treatments should be tailored to the underlying pain mechanism: (A) analgesics, lifestyle modification, endoscopic procedures, and surgery for nociceptive pain; (B) gabapentinoids and celiac plexus block for neuropathic pain; and (C) non-pharmacologic interventions (e.g. exercise, cognitive behavioral therapy, yoga), antidepressants (e.g. duloxetine, amitriptyline), acupuncture and neuromodulation approaches for nociplastic pain.SummaryA mechanism-based management of painful CP is feasible. However, there is a need to further refine the tools to diagnose pain mechanisms at the bedside and to develop more effective interventions for painful CP.
TI - Precision Medicine Treatment for Painful Chronic Pancreatitis
JF - Current Treatment Options in Gastroenterology
DO - 10.1007/s11938-025-00475-7
DA - 2025-06-14
UR - https://www.deepdyve.com/lp/springer-journals/precision-medicine-treatment-for-painful-chronic-pancreatitis-T6mdYqZ2Sn
VL - 23
IS - 1
DP - DeepDyve
ER -