Chronic pancreatits refers to long-term irreversible damage to the pancreas. The organ that lies behind the stomach belongs to two body systems--the digestive and endocrine system. As an integral part of both systems, when damaged, the pancreas causes abnormal digestion and abnormal glucose breakdown. Symptoms of pancreatitis range from mild to severe with abdominal pain associated with meals, nausea, vomiting, back pain, changes in stool and a number of other hallmark symptoms. Treatment goals for pancreatitis alleviate pain and manages complications.
Pain Relief
The most common complaint and the mainstay of chronic pancreatitis treatment involves pain control. Severe abdominal and back pain debilitates patients and must be managed with care. Chronic pancreatitis pain remains complex with various theories surrounding the exact origin of pain. In many cases, persistent pain plagues patients and their managing physicians due to the difficult nature of pain control, according to the Cleveland Clinic.
As an initial step in pain management, patients should avoid and/or discontinue offending substances. The most common cause of chronic pancreatitis is alcohol abuse. For some, eliminating alcohol use may pose a problem, especially if the patient uses alcohol as a way to self medicate. Alcohol progresses chronic pancreatitis. Avoiding other substances that aggravate pancreatitis is also important.
Physicians typically initiate pain management with non-narcotic analgesics. This includes medications like naproxen, ibuprofen, acetaminophen and tramadol. Physicians stress the importance of avoiding narcotics in the early stages of chronic pancreatitis as patients may eventually progress needing additional sources of pain relief.
Narcotics remain a second or third line of management. Recommendations, reported by the Cleveland Clinic, involve the use of mild narcotics in low doses. These include agents like codeine and propoxyphene.
Support for the use of enzymes remains controversial. Research has yet to definitively prove its usefulness in the resolution of pain.
Central nervous system agents, agents that work on the brain, prove useful in some cases. Antidepressants and some antipsychotics promote analgesia. Psychiatric counseling also proves useful in a small amount of cases, states the Cleveland Clinic.
Doctors reserve surgical nerve blocks for the most severe cases of pain without resolution, reports the University of Chicago. Doctors, assisted by computed tomography or ultrasound, inject patients with anesthesia in the spine. This provides temporary pain relief with varying success. A limited number of patients benefit from this procedure.
Digestive Relief
Chronic pancreatitis interferes with normal digestion. The pancreas normally produces enzymes that help digest food in the stomach. As chronic pancreatitis progresses, these enzymes need replacement. Several well-tolerated enzyme supplements exist as options for digestion management. Dosing of enzymes occurs with each meal, half before and half after, according to the Cleveland Clinic.
As part of the digestive regimen, the inclusion of a daily proton pump inhibitor prevents the breakdown of enzymes by hydrochloric acid in the stomach, according to the Cleveland Clinic.
Some doctors recommend a dietitian to improve nutrition with smaller meals, low fat meals, and assist in avoiding complications, according to the University of Chicago.
Complication Relief
Some patients with chronic pancreatitis develop other complications secondary to inflammatory destruction of pancreatic tissue. Typically doctors intervene with surgical treatment removing accumulation of fluid, increasing the size of the pancreatic duct or draining areas of large infections, reports the Cleveland Clinic .
