389
Pam, 43 (1990) 389 Elsevier
PAIN 01688
Abdominal
pain caused by chronic pancreatitis A.P.E.
Vielvoye-Kerkmeer
Pain Clonic, Uniuersrty Hospital L&den. P.O. Box 9600, 2300 RC Leiden (The Netherlands) (Accepted
Dear Editor, With interest I read the article by J. Myhre et al. concerning monitoring of celiac plexus block in chronic pancreatitis (Pain, 38 (1989) 269). The authors draw attention to a serious chronic pain problem. I should like to make a few remarks. Celiac plexus blocks for unknown abdominal pain generally have little success. The patients described by the authors were suffering from chronic pancreatitis. Since patients with a pancreatitis have a longer life expectancy than patients with a carcinoma, pain recurs sooner or later, probably due to regeneration of sympathetic fibers. Repeated plexus block is often less successful, possibly because of the process of regeneration, as the authors also suggested, or the exacerbation of the underlying disease. The authors suggest that a stronger ethanol solution (50%) might be more efficient. Since 1976, all celiac plexus blocks in our clinic have been performed with two 20 ml injections of 50% ethanol solution (10 ml ethanol 96%, 5 ml lidocaine 0.5% and 5 ml IoparniroB 300) under fluoroscopic control. Nevertheless, we have experienced the same overall negative results in chronic pancreatitis.
0304-3959/90/$03.50
0 1990 Elsevier Science Publishers
12 June 1990)
The literature is clear about the tremendous therapeutic potential in contrast to the poor therapeutic success in the treatment of chronic pancreatitis. For this reason, it is my opinion that pain caused by chronic pancreatitis should always be regarded as a chronic benign pain syndrome with all the associated problems such as tolerance, abuse of narcotic analgesics and alcohol, and depression. I should like to receive information about the experience of management teams with regard to this chronic pain syndrome.
References Bell, A.N.,
Colle, R. and Roberts-Thomson, I.C.. Coeliac for control of pain in chronic pancreatitis, Br. Med. J., 181 (1980) 1604. Challenger, L.H., Sympathetic nervous system blocking in pain relief. In: M. Swerdlow (Ed.), Relief of Intractable Pain, Excerpta Medica, Amsterdam, 1974. pp. 189-191. Crook, J. and Tunks, E., Defining the ‘chronic pain syndrome’: an epidemiology method. In: H.L. Fields et al. (Eds.), Advances in Pain Research and Therapy, Vol. 9. Raven Press, New York, 1985, pp. 871-877. Evans, P.J.D., Narcotic addition in patients with chronic pain, Anaesthesia, 36 (1981) 597-602. plexus block
B.V. (Biomedical
Division)
Pam, 43 (1990) 389 Elsevier
PAIN 01688
Abdominal
pain caused by chronic pancreatitis A.P.E.
Vielvoye-Kerkmeer
Pain Clonic, Uniuersrty Hospital L&den. P.O. Box 9600, 2300 RC Leiden (The Netherlands) (Accepted
Dear Editor, With interest I read the article by J. Myhre et al. concerning monitoring of celiac plexus block in chronic pancreatitis (Pain, 38 (1989) 269). The authors draw attention to a serious chronic pain problem. I should like to make a few remarks. Celiac plexus blocks for unknown abdominal pain generally have little success. The patients described by the authors were suffering from chronic pancreatitis. Since patients with a pancreatitis have a longer life expectancy than patients with a carcinoma, pain recurs sooner or later, probably due to regeneration of sympathetic fibers. Repeated plexus block is often less successful, possibly because of the process of regeneration, as the authors also suggested, or the exacerbation of the underlying disease. The authors suggest that a stronger ethanol solution (50%) might be more efficient. Since 1976, all celiac plexus blocks in our clinic have been performed with two 20 ml injections of 50% ethanol solution (10 ml ethanol 96%, 5 ml lidocaine 0.5% and 5 ml IoparniroB 300) under fluoroscopic control. Nevertheless, we have experienced the same overall negative results in chronic pancreatitis.
0304-3959/90/$03.50
0 1990 Elsevier Science Publishers
12 June 1990)
The literature is clear about the tremendous therapeutic potential in contrast to the poor therapeutic success in the treatment of chronic pancreatitis. For this reason, it is my opinion that pain caused by chronic pancreatitis should always be regarded as a chronic benign pain syndrome with all the associated problems such as tolerance, abuse of narcotic analgesics and alcohol, and depression. I should like to receive information about the experience of management teams with regard to this chronic pain syndrome.
References Bell, A.N.,
Colle, R. and Roberts-Thomson, I.C.. Coeliac for control of pain in chronic pancreatitis, Br. Med. J., 181 (1980) 1604. Challenger, L.H., Sympathetic nervous system blocking in pain relief. In: M. Swerdlow (Ed.), Relief of Intractable Pain, Excerpta Medica, Amsterdam, 1974. pp. 189-191. Crook, J. and Tunks, E., Defining the ‘chronic pain syndrome’: an epidemiology method. In: H.L. Fields et al. (Eds.), Advances in Pain Research and Therapy, Vol. 9. Raven Press, New York, 1985, pp. 871-877. Evans, P.J.D., Narcotic addition in patients with chronic pain, Anaesthesia, 36 (1981) 597-602. plexus block
B.V. (Biomedical
Division)
