Mechanism-based Approach to Pain in Chronic Pancreatitis (MAP-CP Study)

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Project Summary Chronic pancreatitis (CP) is often accompanied by profoundly debilitating pain that is quite difficult to treat. There are a large number of analgesics that can be prescribed, but their efficacy often depends on having a mechanistic assessment of the cause and type of pain. Since there are no tools available in clinics to properly characterize the sub-type of pain a patient is experiencing, it is difficult to choose a therapy most likely to provide sufficient pain relief. The identification of biomarker profiles associated with specific sub-types of pain could inform guidelines for pain management that improve patients' quality of life by reducing the time and expense required to administer the efficacious therapies, reduce the number of patients prescribed opioids, and identify novel therapeutic targets. This study is designed to test the hypothesis that patient-derived information can be used to identify pain phenotypes (biomarker profiles) that inform management of CP-related pain. Aim 1 will be cross-sectional analyses to examine the expression pattern of circulating proteins that are known to be important for pain signaling. We will compare these in relation to pain characteristics that have been previously studied including pain intensity, frequency, and interference with quality of life. We will then determine if putative biomarker profiles and pain characteristics can be differentiated based on the underlying pain mechanism (nociceptive versus neuropathic). Aim 2 will involve longitudinal evaluation of whether temporal changes in biomarker profile are associated with changes in clinical symptoms and treatment, such as opioids. This longitudinal study will allow us to describe the natural history of pain within the same patients. Overall, the results from this study will provide in depth data regarding the evolution of pain in CP and guide future studies aimed at predicting therapeutic responsiveness and developing efficacious interventions.