Systematic mechanism-orientated approach to chronic pancreatitis pain

doi:10.3748/wjg.v21.i1.47

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Jan 7, 2015 (publication date) through Jul 5, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jan 7, 2015; 21(1): 47-59
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.47

Table 2 Schematic for systematic mechanism-orientated approach to chronic pancreatitis pain

Questions	Issue	QST	Therapy
Nociceptive source?	Site/agressiveness	Local hyperalgesia	Treat or deafferent
Nociceptive transmission?	Nerve damage	Territorial thermal hyperalgesia	Treat (cave CS!)
Central pain processing?	Central sensitisation	Spreading hyperalgesia	Antihyperalgesia (ketamine, gabapentinoids)
Central pain processing?	Pronociceptive modulation	Sensitisation to CPM paradigm	Activate DI (TCA, NRI)
Autonomy of central pain processing?	Autonomy	No changes in thresholds after therapy	Traget altered central processing

Autonomy means that alterations in central pain processing have become independent of peripheral nociceptive drive. CPM: Conditioned pain modulation; DI: Descending inhibition; TCA: Tricyclic antidepressant; NRI: Noradrenaline reuptake inhibitor; QST: Quantitative sensory testing. This figure is based on the original figure of ref [18].

Citation: Bouwense SA, de Vries M, Schreuder LT, Olesen SS, Frøkjær JB, Drewes AM, van Goor H, Wilder-Smith OH. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol 2015; 21(1): 47-59
URL: https://www.wjgnet.com/1007-9327/full/v21/i1/47.htm
DOI: https://dx.doi.org/10.3748/wjg.v21.i1.47