Chronic Pancreatitis Pain Linked to Declining Physical, Mental Health

Chronic pancreatitis pain affects patients’ physical, psychological, and social health.

Chronic pancreatitis (CP) pain contributes to poor physical, mental, and social health according to study findings in Clinical Gastroenterology and Hepatology.

For the current study, researchers conducted a cross-sectional analysis of the ongoing cohort study, “Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED; ClinicalTrials.gov Identifier: NCT03099850). Using baseline data from the PROCEED study, researchers analyzed patients with CP (n=488) and without CP (control group; n=254).

All study participants completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, a measure of global mental and physical health, and the PROMIS-29 profile, which documented 7 symptom domains. Pain was categorized by severity (none, mild to moderate, severe) and frequency (none, intermittent, constant).

Patients in the CP and control groups had a mean age of 53.7 and 49.1 years; and 50.8% and 51.2% were men, respectively. Patients with chronic pancreatitis were older than the control group and were more likely to be White, non-Hispanic, and have a low or normal body mass index (BMI). Participants in the chronic pancreatitis group reported lower socioeconomic indices based on education, employment, and income.

Although causality cannot be inferred by our study, given the high rate of psychological comorbidities observed and their relationship to chronic disabling pain, it is evident that psychosocial screening and treatment are needed in the clinical management of CP.

The primary cause of chronic pancreatitis in patients was alcohol (42.5%). Of the patients with chronic pancreatitis, 43.6% had diabetes, 42.4% experienced exocrine pancreatic dysfunction, and 73.8% had calcifications.

A total of 84% of participants with chronic pancreatitis reported abdominal pain, with 58.6% rating their pain as severe and 45.7% as constant.

Patients with chronic pancreatitis reported significantly lower PROMIS Global Health than the control group; the most significant differences were in Global Physical Health and Global Mental Health, with standard deviation differences of 1.2 and 0.8, respectively.

Similar trends in the chronic pancreatitis group were observed, with significant decreases for physical, mental, and social health domains of the PROMIS 29 profile (P <.001 for all categories).

A diagnosis of chronic pancreatitis was associated with a decrease of 7.15 points for PROMIS Global Physical Health and a reduction of 3.13 points in Global Mental Health (P <.001).

There were no significant associations between pain and social health factors in groups that reported no pain and mild-moderate pain. However, there were significant reductions in social health scores in patients experiencing severe pain, with differences in pain interference (60.9±10.3), fatigue (56.5±10), and physical function (43.8±9.3) when compared with the control group.

Regarding behavioral differences, participants with chronic pancreatitis met or exceeded thresholds for moderate to severe symptoms of depression, anxiety, sleep disturbance, and low physical function (P <.001). The rate of behavioral comorbidities was 2.11 to 4.74 times greater in chronic pancreatitis, with severe pain and 2.79 to 5.38 times higher in constant chronic pancreatitis pain.

Study limitations include using baseline data without collecting follow-up data, lack of diagnostic assessment of behavioral comorbidities, and limiting pain measurements to severity and temporality.

“Although causality cannot be inferred by our study, given the high rate of psychological comorbidities observed and their relationship to chronic disabling pain, it is evident that psychosocial screening and treatment are needed in the clinical management of CP,” the study authors wrote.

This article originally appeared on Gastroenterology Advisor

References:

Yadav D, Askew RL, Palermo T, et al. Association of chronic pancreatitis pain features with physical, mental, and social health. Clin Gastroenterol Hepatol. Published Online September 30, 2022. doi:10.1016/j.cgh.2022.09.026