Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group.
Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group.
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DOI：
10.1016/j.pan.2015.10.015
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Whitcomb DC
中科院分区：
文献类型：
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作者：
Anderson MA;Akshintala V;Albers KM;Amann ST;Belfer I;Brand R;Chari S;Cote G;Davis BM;Frulloni L;Gelrud A;Guda N;Humar A;Liddle RA;Slivka A;Gupta RS;Szigethy E;Talluri J;Wassef W;Wilcox CM;Windsor J;Yadav D;Whitcomb DC
慢性胰腺炎（CP）患者的疼痛仍然是主要的临床主诉和生活质量差的来源。然而，缺乏关于评估和治疗的明确指导。胰腺疼痛工作组回顾了CP中疼痛机制、临床疼痛评估和疼痛治疗的信息。证据级别使用牛津系统分配，共识基于GRADE。在2012年胰节期间召开了一次共识会议，进行了实质性的会后讨论、辩论和手稿改进。提出了12个讨论问题和建议的指导说明。与会人员得出结论：疾病机制：疼痛的病因是多因素的，但缺乏将症状与病理特征和分子亚型有效联系起来的数据。疼痛评估：疼痛应该在每次临床就诊时进行评估，但缺乏证据来支持评估疼痛特征、频率和严重程度的最佳方法。管理：对内窥镜和手术治疗的作用有普遍的共识，但对医疗、心理、内窥镜、手术和其他治疗的最佳患者选择的共识较少。在疼痛生物学和治疗选择方面正在取得进展，但CP患者的疼痛仍然是一个主要问题，没有得到充分的理解、测量和管理。越来越多的信息需要转化为更有效的临床护理。
Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. Management: There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.