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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Nov 15, 2015; 6(4): 193-202
Published online Nov 15, 2015. doi: 10.4291/wjgp.v6.i4.193
Current understanding of the neuropathophysiology of pain in chronic pancreatitis
Amporn Atsawarungruangkit, Supot Pongprasobchai
Amporn Atsawarungruangkit, Department of Family Medicine, Rajavithi Hospital, Bangkok 10400, Thailand
Supot Pongprasobchai, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok 10700, Thailand
Author contributions: Atsawarungruangkit A and Pongprasopchai S contributed equally to this work including article reviewing and paper writing.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Supot Pongprasobchai, MD, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, 2 Pran-Nok Road, Bangkok 10700, Thailand. supot.pon@mahidol.ac.th
Telephone: +66-1207-0903 Fax: +66-2411-5013
Received: April 10, 2015
Peer-review started: April 12, 2015
First decision: July 10, 2015
Revised: July 22, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 15, 2015
Processing time: 220 Days and 20.8 Hours
Abstract

Chronic pancreatitis (CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure. Traditionally, researchers believed that the pain was caused by anatomical changes in pancreatic structure. However, treatment outcomes based on such beliefs are considered unsatisfactory. The emerging explanations of pain in CP are trending toward neurobiological theories. This article aims to review current evidence regarding the neuropathophysiology of pain in CP and its potential implications for the development of new treatments for pain in CP.

Keywords: Neurobiology; Neuropathophysiology; Pain; Pancreatic pain; Chronic pancreatitis

Core tip: Abdominal pain is the main symptom of patients with chronic pancreatitis (CP), yet the underlying mechanisms are not well understood. The emerging explanations of pain in CP are trending toward neurobiological theories. This article reviews these emerging concepts and their potential implications for the development of new treatments for pain in CP. Three major concepts attempting to explain the pathogenesis of CP pain: Pancreatic nociception and sensitization-induced pain, neuropathic remodeling, and central mechanism of pancreatitis pain are summarized, along with the specific molecules involved in each and potential therapeutic targets.