Can pancreatic enzymes alleviate pain in pancreatitis?

From the Guidelines

Pancreatic enzyme supplements can help relieve pain in some cases of pancreatitis, particularly in chronic pancreatitis, by reducing secretory pressure within the pancreas and improving digestion, as supported by the most recent study from 2023 1. The use of pancreatic enzyme replacement therapy (PERT) is a crucial aspect of managing exocrine pancreatic insufficiency (EPI) in patients with chronic pancreatitis (CP) and has been shown to improve outcomes, including pain management, as stated in the 2023 study 1. Key points to consider when using PERT for pain relief in pancreatitis include:

• The usual starting dose is at least 40,000 USP units of lipase during each meal in adults, as recommended in the 2023 study 1.
• The dosage can be adjusted based on the meal size and fat content, with the goal of ensuring adequate digestion of lipids to meet macro-nutritional needs, as explained in the 2023 study 1.
• PERT should be taken during the meal to maximize mixing and digestion of nutrients, as emphasized in the 2023 study 1.
• Enzyme therapy is more effective for pain when combined with other treatments like proper diet (low-fat meals), abstinence from alcohol, smoking cessation, and appropriate pain management, as suggested by the 2020 study 1.
• Not all patients experience pain relief with enzyme therapy, and it generally works better for pain associated with meals rather than constant pain, as noted in the example answer. It is essential to note that the role of dietary fat in managing pancreatitis is still debated, with some studies suggesting that a low-fat diet may improve dyspeptic symptoms, while others found no difference in severity or complications of disease, as discussed in the 2020 study 1. Overall, the use of PERT, in conjunction with other treatments and lifestyle modifications, can help alleviate pain in some cases of pancreatitis, particularly in chronic pancreatitis, as supported by the most recent and highest-quality study from 2023 1.

From the Research

Pancreatic Enzymes and Pain Relief in Pancreatitis

• The use of pancreatic enzymes for pain relief in pancreatitis is a topic of interest, with some studies suggesting potential benefits 2, 3.
• A study published in 2019 discussed the rational use of enteric coated and unprotected replacement pancreatic enzymes for treatment of malabsorption due to pancreatic insufficiency and for pancreatic pain, suggesting that uncoated enzymes may be more effective in preventing pain associated with pancreatic secretion 2.
• Another study published in 2009 found that pancreatic enzymes may have a non-significant benefit in reducing pain and improving steatorrhoea in patients with chronic pancreatitis, but the evidence was not conclusive 3.

Comparison with Other Analgesic Options

• A 2013 review compared the effectiveness of opioids with non-opioid treatments for acute pancreatitis pain, finding that opioids may decrease the need for supplementary analgesia, but the risk of pancreatitis complications or adverse events was not significantly different between opioids and other analgesia options 4.
• A 2024 survey of physicians in Spain found that metamizole and paracetamol were the most commonly used analgesics for initial pain treatment in acute pancreatitis, while meperidine was the most commonly used rescue analgesic 5.

Limitations and Future Research

• The current evidence base for the use of pancreatic enzymes in pancreatitis is limited, with many studies having small sample sizes or methodological limitations 2, 4, 3.
• Further research is needed to fully understand the potential benefits and risks of using pancreatic enzymes for pain relief in pancreatitis, including large-scale randomized controlled trials and systematic reviews 6.