Commentary

Abstract

The indications for surgery in the management of chronic pancreatitis are well formulated: suspicion of cancer, biliary stenosis, duodenal stenosis, arterial erosion, splenic vein occlusion, internal pancreatic fistulae, and pancreatic pseudocyst, but there is no doubt, however, that the chief indication for surgical management of chronic pancreatitis in our experience is intractable pain. Patients with chronic pancreatitis and intractable pain are marginalized and stigmatized by health care providers because of the assumption that patients with chronic pancreatitis are responsible for their own pain and suffering due to a character flaw associated with chronic alcoholism and narcotic drug dependence. Mechanisms of pain in chronic pancreatitis remain poorly understood. The ductal hypertension theory of Puestow, the parenchymal hypertension theory of Reber, and the perineural inflammation theory of Bockman and Keith have improved our understanding of pain in chronic pancreatitis but have not elucidated more successful surgical therapies in the management of intractable pain associated with chronic pancreatitis.