Eur J Pain. 2021 Nov 10. doi: 10.1002/ejp.1885. Online ahead of print.
ABSTRACT
INTRODUCTION: Pain is the most common symptom in acute pancreatitis (AP) and is among the diagnostic criteria. Therefore, we aimed to characterize acute abdominal pain in AP.
METHODS: The Hungarian Pancreatic Study Group prospectively collected multicenter clinical data on 1435 adult AP patients between 2012 and 2017. Pain was characterized by its intensity (mild or intense), duration prior to admission (hours), localization (nine regions of the abdomen), and type (sharp, dull, or cramping).
RESULTS: 97.3% of patients (n=1394) had pain on admission. Of the initial population with acute abdominal pain, 727 patients answered questions about pain intensity, 1148 about pain type, 1134 about pain localization, and 1202 about pain duration. Pain was mostly intense (70%, n=511/727), characterized by cramping (61%, n=705/1148), mostly starting less than 24 hours prior to admission (56.7%, n=682/1202). Interestingly, 50.9% of the patients (n=577/1134) had atypical pain, which means pain other than epigastric or belt-like upper abdominal pain. We observed a higher proportion of peripancreatic fluid collection (19.5% vs. 11.0%; p=0.009) and edematous pancreas (8.4% vs. 3.1%; p=0.016) with intense pain. Sharp pain was associated with AP severity (OR=2.481 95% CI: 1.550-3.969) and increased mortality (OR=2.263, 95% CI: 1.199-4.059) compared to other types. Longstanding pain (>72 h) on admission was not associated with outcomes. Pain characteristics showed little association with the patient's baseline characteristics.
CONCLUSION: A comprehensive patient interview should include questions about pain characteristics, including pain type. Patients with sharp and intense pain might need special monitoring and tailored pain management.
PMID:34758174 | DOI:10.1002/ejp.1885