From the Guidelines
Pancreatitis pain is a severe, constant aching or burning sensation in the upper abdomen, often radiating to the back, and is typically one of the worst pains a patient has ever experienced. The pain is usually located in the middle of the abdomen, just below the ribs, and can be extremely intense 1. Many patients describe the pain as worsening after eating, particularly fatty foods, and may be accompanied by nausea, vomiting, and tenderness when touching the abdomen. In acute pancreatitis, the pain typically comes on suddenly and may be severe enough to send someone to the emergency room, while chronic pancreatitis pain can be persistent but less intense, sometimes with periodic flare-ups. Some key characteristics of pancreatitis pain include:
- Severe, constant aching or burning sensation in the upper abdomen
- Pain often radiates to the back
- Worsens after eating, particularly fatty foods
- May be accompanied by nausea, vomiting, and tenderness when touching the abdomen
- Can be extremely intense, often described as one of the worst pains a patient has ever experienced The pain occurs because inflammation of the pancreas irritates the organ itself and the surrounding tissues and nerves, with digestive enzymes that normally are only activated in the small intestine becoming activated within the pancreas, essentially causing the organ to digest itself, which triggers intense pain signals 1. If you experience this type of severe abdominal pain, especially if accompanied by fever, rapid pulse, or vomiting, you should seek immediate medical attention as pancreatitis can be life-threatening if not treated promptly.
From the Research
Pancreatitis Pain Characteristics
- Pancreatitis pain is usually accompanied by nausea, vomiting, and fever 2
- The pain is mostly intense (70%), characterized by cramping (61%), and mostly starts less than 24 hours prior to admission 3
- Atypical pain, which means pain other than epigastric or belt-like upper abdominal pain, is present in 50.9% of patients 3
- Sharp pain is associated with acute pancreatitis severity and increased mortality compared to other types of pain 3
Pain Management
- Opioids may be an appropriate choice in the treatment of acute pancreatitis pain, and may decrease the need for supplementary analgesia 2
- Epidural analgesia appears to provide the greatest improvement in pain scores within the first 24 hours, but is equivalent to opiates by 48 hours 4
- NSAIDs offered similar pain-relief to opiates within 24 hours, while placebo also showed equivalence to other modalities but then plateaued 4
- Local anaesthetics demonstrated the least overall efficacy in pain management 4
Assessment of Pain
- Generic pain instruments are valid in most settings, but aspects of pain are specific for chronic pancreatitis 5
- Instruments have to account for the wide phenotypic variability and development of sensitization of the central nervous system 5
- Multidimensional questionnaires are validated for chronic pancreatitis and are recommended together with assessment of quality of life and psychiatric co-morbidities 5