Pharmacological pain management in chronic pancreatitis

Table 1 Recommended risk factor modifications in chronic pancreatitis according to the MANNHEIM criteria

Risk factor	Treatment	Comments
Alcohol	Alcohol cessation	Decrease disease progression and may have beneficial effects on pain
Nicotine	Smoking cessation	Decrease disease progression and may have beneficial effects on pain
Nutritional	No specific recommendations	No prospective data
Hereditary	Endoscopic surveillance	Currently no formal evidence, a prospective trial has been initiated
	Pancreatectomy with autolog stem cell transplantation	Preferred strategy in some United States centers
Efferent duct	Endoscopy or surgical interventions	The benefit of intervention is controversial
Immunological	Steroid treatment	Treatment of autoimmune pancreatitis follows guidelines provided in e.g., Ref. 32
Metabolic	Lipid lowering therapy, parathyroidectomy, etc.	Consider referral to an endocrinologist