Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study

• Published in: Gut Vol. 60; no. 1; pp. 77 - 84
• Main Authors: Mullady, Daniel K, Yadav, Dhiraj, Amann, Stephen T, O'Connell, Michael R, Barmada, Michael M, Elta, Grace H, Scheiman, James M, Wamsteker, Erik-Jan, Chey, William D, Korneffel, Meredith L, Weinman, Beth M, Slivka, Adam, Sherman, Stuart, Hawes, Robert H, Brand, Randall E, Burton, Frank R, Lewis, Michele D, Gardner, Timothy B, Gelrud, Andres, DiSario, James, Baillie, John, Banks, Peter A, Whitcomb, David C, Anderson, Michelle A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.01.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Abdominal pain; Absenteeism; Adult; Aged; Alcohol Drinking - adverse effects; Alcohol Drinking - epidemiology; Biological and medical sciences; Chronic Disease; Chronic illnesses; chronic pancreatitis; Disability; Disability Evaluation; Epidemiologic Methods; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health Resources - statistics & numerical data; Hospitalization - statistics & numerical data; Hospitals; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Middle Aged; Other diseases. Semiology; Pain; Pain - epidemiology; Pain - etiology; Pain Measurement - methods; Pancreas; Pancreatitis; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - epidemiology; Patients; Quality of Life; Smoking - adverse effects; Smoking - epidemiology; Studies; United States - epidemiology; United States > US; California; Disability; Chronic; Pain; Cohort study; Gastroenterology; Pancreatitis; Digestive diseases; Complication; Pancreatic disease; Quality of life
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gut.2010.213835

ObjectiveTo compare patients with chronic pancreatitis (CP) with constant pain patterns to patients with CP with intermittent pain patterns.MethodsThis was a prospective cohort study conducted at 20 tertiary medical centers in the USA comprising 540 subjects with CP. Patients with CP were asked to identify their pain from five pain patterns (A–E) defined by the temporal nature (intermittent or constant) and the severity of the pain (mild, moderate or severe). Pain pattern types were compared with respect to a variety of demographic, quality of life (QOL) and clinical parameters. Rates of disability were the primary outcome. Secondary outcomes included: use of pain medications, days lost from school or work, hospitalisations (preceding year and lifetime) and QOL as measured using the Short Form-12 (SF-12) questionnaire.ResultsOf the 540 CP patients, 414 patients (77%) self-identified with a particular pain pattern and were analysed. Patients with constant pain, regardless of severity, had higher rates of disability, hospitalisation and pain medication use than patients with intermittent pain. Patients with constant pain had lower QOL (by SF-12) compared with patients who had intermittent pain. Additionally, patients with constant pain were more likely to have alcohol as the aetiology for their pancreatitis. There was no association between the duration of the disease and the quality or severity of the pain.ConclusionsThis is the largest study ever conducted of pain in CP. These findings suggest that the temporal nature of pain is a more important determinant of health-related QOL and healthcare utilisation than pain severity. In contrast to previous studies, the pain associated with CP was not found to change in quality over time. These results have important implications for improving our understanding of the mechanisms underlying pain in CP and for the goals of future treatments and interventions.