Acute Pancreatitis: Pain and Analgesia

Abdominal pain is the presenting and dominating symptom in almost all patients with acute pancreatitis (AP) and is a diagnostic criterion. This requires that the abdominal pain is typical of AP and that there is either a significant elevation (≥3-fold) of pancreatic enzymes (lipase or amylase) or evidence of pancreatic inflammation on cross-sectional imaging. The assessment of pain is usually confined to pain intensity and a 1–10 visual analogue scale is typically used. There are no specific and validated scales for pain assessment in AP, although these are available for patients with chronic pancreatitis. Furthermore guidelines and recommendations for the management of pain in patients with AP are not consistent meaning that pain management strategies are often extrapolated from management of other painful abdominal conditions. In fact, the IAP/APA guidelines for management of AP do not mention pain management, and no recommendations were given in the AGA guidelines from 2018. In a recent The Lancet review, it was only mentioned that no analgesics are superior and that opioids may decrease the need for supplementary analgesics. As pain is the most important symptom in AP, it is astonishing that there are no specific recommendations for pain management in the international literature, reflecting the urgent need for more research.