Pain management in chronic pancreatitis

2019-06-26
Miroslav Vujasinovic

What are the principles of pain management in patients with chronic pancreatitis? Can we use strong opioids?

Miroslav Vujasinovic, MD, PhD: This is the most difficult question for me. In my everyday clinical work, I think pain management is definitely the most demanding aspect. All other topics we can discuss, debate.

Right now, we are following the World Health Organization (WHO) step-up approach, but the first step, that means paracetamol, very rarely helps, so quite fast we come to the second level.

On the second level there are nonsteroidal anti-inflammatory drugs that we absolutely try to avoid in this group of patients due to the side effects. Basically, tramadol is probably the best, and I personally had the best experience with tramadol. If it is possible, I like to manage the patient with the highest possible dose of tramadol.

Unfortunately, a lot of patients are coming to opioids, especially in the Scandinavian countries, where the frequency of prescription of opioids is very high. And that is why unfortunately we have also a lot of side effects: narcotic bowel syndrome, obstipation, dependency. Sometimes we try the top-down approach, from opioids to tramadol, but it is not very easy. It is very demanding. My personal favorite is the second level, with tramadol.

We would love to hear from you

  • Do you have any comments?
  • Have you found a mistake?
  • Would you like to suggest a feature?

We use cookies to ensure you get the best browsing experience on our website. Refer to our Cookies Information and Privacy Policy for more details.