Descending Inhibitory Pain Modulation Is Impaired in Patients With Chronic Pancreatitis

Background & Aims Pain is a prominent symptom in chronic pancreatitis (CP), but the underlying mechanisms are incompletely understood. We investigated the role of descending pain modulation from supraspinal structures as well as central nervous system sensitization in patients with pain from CP. Methods Twenty-five patients with CP and 15 healthy volunteers were included. Descending pain modulation was investigated by diffuse noxious inhibitory control (a descending inhibitory response after conditioning stimulation). Central pain processing was investigated as the perceptual responses to multimodal (electrical, thermal, and mechanical) stimulations of the rectosigmoid and evoked brain potentials after electrical stimulation of the rectosigmoid. Results Compared with healthy volunteers, the efficacy of diffuse noxious inhibitory control was reduced in patients with CP (13% ± 21% vs 39% ± 22%, respectively; F = 3.8; P = .01); central sensitization was indicated by remote hyperalgesia in the rectosigmoid to electrical stimulation (21 ± 15 mA vs 27 ± 15 mA; F = 6.2; P = .02) and heat stimulation (51°C ± 5°C vs 53°C ± 4°C; F = 5.9; P = .02). Compared with controls, patients with CP had increased latency of the early P1 peak to rectosigmoid stimulation (85 ± 21 ms vs 108 ± 28 ms, respectively; P = .02), possibly reflecting reorganization of central pain pathways. Conclusions Patients with CP have impairments in inhibitory pain modulation and evidence of central sensitization. Treatment of their pain therefore should focus not only on the pancreas, but also on descending pain modulation from supraspinal structures and central nervous system sensitization.