Pharmacological pain management in chronic pancreatitis

Table 3 Current available pharmacological treatments for pain in chronic pancreatitis

Pain mechanism	Treatment option(s)	Comments	Ref.
Raised levels of CCK	Pancreatic enzyme replacement therapy	Only non-enteric coated enzymes have proven effective	[57-65]
	Somatostatin-analogues	Conflicting results, prolonged release formulations may be of value	[67,68]
Pancreatic inflammation and oxidative stress	Antioxidants	Conflicting results, probably most valuable in tropical calcifying CP	[71,72]
Central sensitisation	Antidepressants (TCA, SSRI, SNRI)	Expert opinion, no clinical data (Ref.)	[2]
	Gabapentinoids (Gabapentin/Pregabalin)	Modest effect on pain in a randomised placebo controlled trial (Pregabalin)	[42]
	Ketamine	Reverses hyperalgesia in an experimental pain study	[54]
Analgesics	Tramadol vs morphine	No difference in pain relief in a randomised controlled trial, fewer side effects on tramadol treatment	[35]
	Fentanyl vs Morphine	No difference in pain relief in a randomised controlled trial	[41]
	Oxycodone vs Morphine	Oxycodone superior to morphine on experimental pain measures	[39]
	ADL 10-0101:KOR agonist	KOR agonist superior to morphine on experimental and clinical pain measures. Limited number of patients (n = 6)	[40]

CCK: Cholecystokinin; CP: Chronic pancreatitis; TCA: Tricyclic antidepressant; SSRI: Selective serotonin reuptake inhibitor; SNRI: Serotonin norepinephrine reuptake inhibitor; KOR: Kappa opioid receptor.