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Pancreatitis

from Chief complaints and diagnoses

Published online by Cambridge University Press:  18 December 2009

By
Stephen H. Thomas  and
Jonathan S. Ilgen
Edited by
Stephen H. Thomas
Stephen H. Thomas
Affiliation:
Harvard Medical School
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Summary

Opioids remain the most commonly used, and most commonly recommended, treatment for acute (and acute-on-chronic) pancreatitis. Most of the opioids are acceptable, there are reasons to select the mixed agonist-antagonist buprenorphine. Buprenorphine appears to have advantages related to paucity of effect on Oddi's sphincter. There is conflicting information as to the role of NSAIDs in treating pancreatitis pain. One expert consensus panel included NSAIDs as a first-line treatment for flares of chronic pancreatitis. The cholecystokinin (CCK)-receptor antagonists proglumide and loxiglumide appear to be effective in ameliorating pain from acute exacerbations of pancreatitis. One study demonstrated improvement in both subjective and objective (laboratory) parameters. Given potent inhibitory effects on pancreatic secretion, somatostatin and its analog octreotide have been studied for use in pancreatitis. Prophylactic somatostatin may reduce the rate of pancreatitis after endoscopic retrograde cholangiopancreatography. However, the acute care indications for this drug class are less clear.

Keywords

anticonvulsantsdiabetic neuropathylidocainelocal anestheticsserotonin-norepinephrine reuptake inhibitortricyclic antidepressantsneuropathic pain
Type
Chapter
Information
Emergency Department Analgesia
An Evidence-Based Guide
 , pp. 339 - 343
Publisher: Cambridge University Press
Print publication year: 2008

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