Pain, 46 (1991) 231 0 1991 Elsevier Science
231 Publishers
B.V. 0304-3959/91/$03.50
PAIN 01880
Letters to the Editor Pain in chronic pancreatitis A.P.E. Vielvoye-Kerkmeer Pain Clinic, Uniwrsity Hospital Leiden, 2300 RC Leiden (The Netherlands) (Accepted
Dear Editor, With interest I read the reply of Dr. Hilsted and Dr. Worning to my letter (Pain, 43 (1990) 389) concerning the article by J. Myhre et al. (Pain, 38 (19891 269). Our different opinions about pain in patients with chronic pancreatitis are probably based on the different population we have to deal with. The frequency of pain in alcohol-induced chronic pancreatitis is high. Already from the beginning of the disease [l] and before visiting a multidisciplinary pain center a considerable time is spent with the patient to convince him of the importance of total abstinence [2]. Nearly all our patients with chronic pancreatitis are known with an abuse of narcotic analgesics, as meperidine (pethidine) and pentazocine and mostly still an abuse of alcohol. In these patients the use of peroral opioid treatment, as the colleagues Hilsted and Worning are suggesting, is impossible. The patients cannot accept the peroral route and even not another opioid drug because of the extreme psychomimetic effect of meperidine and pentazocine, often used in doses of 15-30 ampullas parenteral/24 h. Next to a primary somatic source of the disease, maybe a neuro-immune disorder [3], there is a primary addiction problem.
Correspondence to: Dr. A.P.E. Vielvoye-Kerkmeer, thesiologist, Pain Clinic, University Hospital Leiden, 2300 RC Leiden. The Netherlands.
M.D., AnesP.O. Box 9600,
20 March
1991)
Hilsted and Worning do not totally agree with the benign character of the disease, but with all the problems of a benign pain syndrome, as doctors shopping, abuse of narcotics and depression, there is a poor quality of life. This may result in mortality due to suicide. As long as the pathogenesis of chronic pancreatitis is unclear and many morphologic varieties are present, surgical intervention will be the best option for a possible treatment. Any treatment has to start as soon as possible to prevent addiction to opioids next to the addiction to alcohol and to overcome the poor quality of life. If the patient just ends up in this phase of his disease it is unexpectable that celiac plexus block or analgetic regimen will relieve the pain.
References Domschke, W., The role of analgesic treatment in chronic pancreatitis. In: H.G. Berger, M. Biichler, H. Ditschuneit and P. Malfertheiner (Eds.), Chronic Pancreatitis, Springer, Berlin, 1990, p. 345. Domschke, W., The role of analgesic treatment in chronic pancreatitis. In: H.G. Berger, M. Biichler, H. Ditschuneit and P. Malfertheiner (Eds.), Chronic Pancreatitis, Springer, Berlin, 1990, p. 346. Weihe, E., Biichler, M., Miiller, S., Friess, H., Zentel, H.J. and Yanaihara, N., Peptidergic innervation in chronic pancreatitis. In: H.G. Berger, M. Biichler, H. Ditschuneit and P. Malfertheiner (Eds.), Chronic Pancreatitis, Springer, Berlin, 1990, p. 99.
231 Publishers
B.V. 0304-3959/91/$03.50
PAIN 01880
Letters to the Editor Pain in chronic pancreatitis A.P.E. Vielvoye-Kerkmeer Pain Clinic, Uniwrsity Hospital Leiden, 2300 RC Leiden (The Netherlands) (Accepted
Dear Editor, With interest I read the reply of Dr. Hilsted and Dr. Worning to my letter (Pain, 43 (1990) 389) concerning the article by J. Myhre et al. (Pain, 38 (19891 269). Our different opinions about pain in patients with chronic pancreatitis are probably based on the different population we have to deal with. The frequency of pain in alcohol-induced chronic pancreatitis is high. Already from the beginning of the disease [l] and before visiting a multidisciplinary pain center a considerable time is spent with the patient to convince him of the importance of total abstinence [2]. Nearly all our patients with chronic pancreatitis are known with an abuse of narcotic analgesics, as meperidine (pethidine) and pentazocine and mostly still an abuse of alcohol. In these patients the use of peroral opioid treatment, as the colleagues Hilsted and Worning are suggesting, is impossible. The patients cannot accept the peroral route and even not another opioid drug because of the extreme psychomimetic effect of meperidine and pentazocine, often used in doses of 15-30 ampullas parenteral/24 h. Next to a primary somatic source of the disease, maybe a neuro-immune disorder [3], there is a primary addiction problem.
Correspondence to: Dr. A.P.E. Vielvoye-Kerkmeer, thesiologist, Pain Clinic, University Hospital Leiden, 2300 RC Leiden. The Netherlands.
M.D., AnesP.O. Box 9600,
20 March
1991)
Hilsted and Worning do not totally agree with the benign character of the disease, but with all the problems of a benign pain syndrome, as doctors shopping, abuse of narcotics and depression, there is a poor quality of life. This may result in mortality due to suicide. As long as the pathogenesis of chronic pancreatitis is unclear and many morphologic varieties are present, surgical intervention will be the best option for a possible treatment. Any treatment has to start as soon as possible to prevent addiction to opioids next to the addiction to alcohol and to overcome the poor quality of life. If the patient just ends up in this phase of his disease it is unexpectable that celiac plexus block or analgetic regimen will relieve the pain.
References Domschke, W., The role of analgesic treatment in chronic pancreatitis. In: H.G. Berger, M. Biichler, H. Ditschuneit and P. Malfertheiner (Eds.), Chronic Pancreatitis, Springer, Berlin, 1990, p. 345. Domschke, W., The role of analgesic treatment in chronic pancreatitis. In: H.G. Berger, M. Biichler, H. Ditschuneit and P. Malfertheiner (Eds.), Chronic Pancreatitis, Springer, Berlin, 1990, p. 346. Weihe, E., Biichler, M., Miiller, S., Friess, H., Zentel, H.J. and Yanaihara, N., Peptidergic innervation in chronic pancreatitis. In: H.G. Berger, M. Biichler, H. Ditschuneit and P. Malfertheiner (Eds.), Chronic Pancreatitis, Springer, Berlin, 1990, p. 99.
