The perception of pain is a common reason why patients see their physicians. Pain is also an important concern after surgery.
USC offers a specialized program for management of pain. Treatment of patients with chronic (long-standing) pain is complex and often requires involvement of a multidisciplinary team that includes a pancreatic surgeon, gastroenterologist, pain physician and a psychiatrist. This comprehensive evaluation of pain is important for optimal outcome.
Treatment of postoperative (post surgical) pain
Over the past two decades there has been a significant improvement in the treatment of pain after surgery. Most patients are provided with excellent pain relief after surgery and experience only minimal discomfort.
Good management of postoperative pain is very important not only for comfort reasons, but also to encourage the patient to carry out chest physiotherapy exercises such as utilizing the incentive spirometer to prevent post operative pneumonia and collapse of the lung that is otherwise common with a large abdominal incision that are often made for big operations on the pancreas and the liver.
The following techniques are utilized for control of post-surgical pain at USC:
Pain in chronic pancreatitis:
Pain is the most common reason for presentation of a patient to a physician with chronic pancreatitis and is the major reason for surgery in chronic pancreatitis. The cause for pain in chronic pancreatitis is complex and the exact reason for pain is not known.
It is thought that two major reasons contribute to pain in chronic pancreatitis:
Treatment of pain from chronic pancreatitis
A patient who presents with pain from chronic pancreatitis requires careful evaluation prior to any form of surgery. These patients have complex psychosocial problems associated with long usage of narcotic type of pain medications over many years for relief of their pain.
In many patients chemical dependency on alcohol and narcotic pain medication are difficult to distinguish from true pain originating from the pancreas. A careful evaluation of the patient for chemical dependency is critical for good outcome from surgery since patients who have chemical dependency would continue to be dependant on narcotic pain medication leading to poor results from the surgery. Furthermore, alcohol addiction is crucial to recognize prior to surgery since the results of the surgery for pain is not good if the pain continues to abuse alcohol. Removal of parts of the pancreas in a patient who continues to abuse alcohol may produce dangerous side effects associated with low blood sugar.
In many patients a careful psychiatric evaluation may be required to distinguish between a chemical dependency and severe pain chronic pancreatitis. Furthermore many patients may have both severe pain from chronic pancreatitis and a chemical dependency that is difficult to resolve until the patient has undergone surgery. In these patients post-operative treatment for chemical dependency is critical for good long-term results.
Surgical treatment for pain in chronic pancreatitis is described elsewhere on this web site. It is important to note that at USC patients under go a comprehensive evaluation for the severity of their disease, psychosocial factors, and chemical dependency prior to any form of surgical treatment. Surgery is offered in selected patients only.
Modern surgical operations that minimize side effects and preserve organ function such as isolated pancreatic head resections are the preferred procedures for treatment of pain from chronic pancreatitis at USC.
Pain in pancreatic cancer
Severe abdominal and back pain is a significant complication in patients who develop unresectable (surgically not removable) pancreatic cancer. Management of pain is important for providing good palliation in patients with advanced pancreatic cancer.
The following options are available at USC for treatment of chronic pain in pancreatic cancer:
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