What medication is used for chronic pancreatitis?

What medication is used for chronic pancreatitis?

HEMANT M. KOCHER, Queen Mary, London, United Kingdom

Am Fam Physician. 2008;77(5):661-662

Author disclosure: Solvay Pharmaceuticals and Lily Oncology have given educational grants to Hemant M. Kocher to run the London Pancreas Workshop 2006.

Chronic pancreatitis is characterized by longstanding inflammation of the pancreas owing to a wide variety of causes, including recurrent acute attacks of pancreatitis.

• Chronic pancreatitis affects three to nine out of 100,000 persons; 70 percent of cases are alcohol induced.

Pancreatic enzyme supplements reduce steatorrhea in persons with chronic pancreatitis, but it seems that they have no effect on pain.

• We do not know whether consuming a low-fat diet or avoiding alcohol consumption improves symptoms of chronic pancreatitis. We also do not know whether calcium or vitamin and antioxidant supplements are effective.

There is consensus that tramadol is the most effective oral opioid analgesic for reducing pain in persons with chronic pancreatitis; however, tramadol is associated with gastrointestinal adverse effects.

• We do not know whether nerve blocks are effective.

There is consensus that endoscopic and surgical pseu-docyst decompression or ductal decompression have benefits and harms; it is unclear which technique is best, and the choice often depends on local expertise.

• There is consensus that, despite complications, biliary decompression is essential in persons with chronic pancreatitis who have biliary obstruction.

Resection using pancreatoduodenectomy may be equivalent to localized excision of the pancreatic head in improving symptoms, but it reduces quality of life and increases intraoperative and postoperative complications. In clinical practice, resection using pancreatoduo-denectomy is usually reserved for when other surgical options, such as pseudocyst or duct decompression, are not feasible because of disease severity.

• There is consensus that distal pancreatectomy may be a viable option in persons with chronic pancreatitis limited to the tail of the pancreas and is most effective when multiple pseudocysts are present. Distal pan-createctomy is associated with complications in 15 to 50 percent of patients.

Definition

Pancreatitis is inflammation of the pancreas. The inflammation may be sudden (acute) or ongoing (chronic). Acute pancreatitis usually involves a single attack, after which the pancreas returns to normal. Chronic pancreatitis is characterized by long-standing inflammation of the pancreas owing to a wide variety of causes, including recurrent acute attacks of pancreatitis. Symptoms of chronic pancreatitis include recurring or persistent abdominal pain and impaired exocrine function. The most reliable test of exocrine function is the demonstration of increased fecal fat, although this test is typically not performed if imaging findings are consistent (particularly calcification of the pancreatic gland on computed tomography).

Diagnosis. There is no consensus on the diagnostic criteria for chronic pancreatitis. Typical symptoms include pain radiating to the back, and persons may present with malabsorption, malnutrition, or pancreatic endocrine insufficiency. However, these symptoms may occur in persons with more common disorders such as reflux disease and peptic ulcers (also more common with heavy alcohol consumption) and in persons with more serious diseases such as pancreatic or periampullary cancers. Diagnostic tests for chronic pancreatitis include fecal elastase measurement (to confirm pancreatic insufficiency) and imaging. Biopsy may be required to resolve diagnostic uncertainty.

Incidence and Prevalence

The annual incidence of chronic pancreatitis has been estimated in one prospective study and several retrospective studies to be between three and nine cases per 100,000 persons. Prevalence is estimated to be between 0.04 and 5 percent. Alcohol-induced chronic pancreatitis is usually diagnosed after a long history of alcohol abuse; alcohol is the most common cause.

Etiology

The TIGAR-O system describes the main predisposing factors for chronic pancreatitis: Toxic-metabolic (which includes alcohol induced [70 percent of all cases], smoking, hypercalcemia, hyperlipidemia, and chronic renal failure); Idiopathic (which includes tropical pancreatitis and may form in up to 20 percent of all cases); Genetic (which includes cationic trypsinogen, cystic fibrosis transmembrane regulator, and serine peptidase inhibitor, Kazal type 1, mutation); Autoimmune (which includes solitary and syndromic); Recurrent and severe acute pancreatitis (which includes postnecrotic and radiation induced); and Obstructive (which includes pancreatic divisum and duct obstruction owing to various causes). Although 70 percent of persons with chronic pancreatitis report excessive consumption of alcohol (i.e., more than 150 g per day) over a long period (more than 20 years), only one in 10 heavy drinkers develop chronic pancreatitis. This suggests an underlying genetic predisposition or polymorphism, although a conclusive link has not been established.

Prognosis

Mortality in persons with chronic pancreatitis is higher than in the general population, with a mortality rate 10 years after diagnosis estimated at 70 to 80 percent. Diagnosis is usually made at 40 to 48 years of age. Reported causes of mortality in persons with chronic pancreatitis are complications of disease or treatment; development of pancreatic cancer or diabetes; and continual exposure to risk factors for mortality, such as smoking and alcohol use.

Treatment — Chronic pancreatitis

The most important thing you can do is stop drinking alcohol, even if it isn’t the cause of your condition. This prevents further damage to your pancreas and may reduce the pain.

If you continue to drink alcohol, it’s likely you’ll experience pain that stops you carrying out your day-to-day activities and also be more likely to develop complications.

Some people with chronic pancreatitis have a dependency on alcohol and need help and support to stop drinking. See your GP if this applies to you.

Treatment for alcohol dependence includes:

• one-to-one counselling
• attending self-help groups – such as Alcoholics Anonymous
• taking a medicine, called acamprosate, that can reduce cravings for alcohol

Stopping smoking

If you smoke, you should stop. Smoking can speed up the damage caused by chronic pancreatitis, making it more likely your pancreas will stop working sooner.

You can use an anti-smoking treatment such as nicotine replacement therapy (NRT) or bupropion – a medicine used to reduce cravings for cigarettes.

See a GP for help and advice about quitting. They can refer you to an NHS Stop Smoking support service or you can call the NHS Stop Smoking helpline on 0300 123 1044 (England only) for more advice.

Dietary changes

Because chronic pancreatitis can affect your ability to digest certain foods, you may need to change your diet.

A GP may be able to provide you with dietary advice, or you can ask them or your hospital doctor to refer you to a dietitian who will draw up a suitable dietary plan.

A low-fat, high-protein, high-calorie diet with fat-soluble vitamin supplements is usually recommended. But do not make changes to your diet without consulting a health professional.

Enzyme supplements

You may be given pancreatic enzyme supplements to help your digestive system work more effectively.

Side effects of these supplements include diarrhoea, constipation, feeling sick, vomiting and tummy pains. See a GP if you experience side effects, as your dosage may need to be adjusted.

Steroid medicine

Steroid medicine is recommended for people with chronic pancreatitis caused by problems with the immune system because it helps to relieve the inflammation of the pancreas.

However, taking steroid medication for a long time can cause side effects such as osteoporosis and weight gain.

Pain relief

Pain relief is an important part of the treatment of chronic pancreatitis.

Mild painkillers

In most cases, the first painkillers used are paracetamol, or anti-inflammatories such as ibuprofen.

But taking anti-inflammatory painkillers on a long-term basis can increase your risk of developing stomach ulcers, so you may be prescribed a proton pump inhibitor (PPI) to protect against this.

Stronger painkillers

If paracetamol or anti-inflammatories don’t control the pain, you may need an opiate-based painkiller, such as codeine or tramadol. Side effects include constipation, nausea, vomiting and drowsiness.

Constipation can be particularly difficult to manage, so you may be prescribed a laxative to help relieve this. See the page on constipation for more information.

If you feel drowsy after taking an opiate-based painkiller, avoid driving and using heavy tools or machines.

Severe pain

If your pain is severe, you may be referred to a specialist (a gastroenterologist or pancreatico-biliary surgeon) or pain centre for further assessment.

You may be offered surgery to help relieve the pain or treat any complications.

In some cases, additional medicine – called amitriptyline, gabapentin or pregabalin – may be recommended to help relieve the pain.

If this isn’t effective, severe pain can sometimes be relieved for a few weeks or months using an injection called a nerve block. This blocks the pain signals from the pancreas.

Severe episodes

If the inflammation of your pancreas suddenly gets worse, you may need a short stay in hospital for treatment.

This might involve having fluids delivered directly into a vein and oxygen through tubes into your nose.

Surgery

Surgery can be used to treat severe pain in people with chronic pancreatitis.

Endoscopic surgery

Patients with gallstones in the opening of their pancreas (the pancreatic duct) may benefit from endoscopic surgery and a treatment called lithotripsy.

Lithotripsy involves using shock waves to break the stones into smaller pieces. An endoscope is then used to access the pancreatic duct so the pieces can be removed.

This treatment may improve pain to some extent, but the benefit may not be permanent.

Pancreas resection

In cases where specific parts of the pancreas are inflamed and causing severe pain, they can be surgically removed. This is called a pancreas resection and may also be offered if endoscopic treatment doesn’t work.

The exact technique used for pancreas resection depends on which parts need to be removed.

Speak with your surgical team about the benefits and risks of the procedure before deciding to go ahead with it.

Total pancreatectomy

In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas (total pancreatectomy).

This can be very effective in treating pain, but you wont be able to produce the insulin that’s needed by your body any more. To overcome this problem, a technique called autologous pancreatic islet cell transplantation (APICT) is sometimes used.

During APICT, the islet cells responsible for producing insulin are removed from your pancreas before your pancreas is surgically removed. The islet cells are then mixed with a special solution and injected into your liver.

If APICT is successful, the islet cells remain in your liver and begin to produce insulin.

In the short term, APICT appears to be effective, but you may need additional insulin treatment in the long term.

Other tests and checks

If you’ve been diagnosed with chronic pancreatitis, you should be offered:

• annual checks (every 6 months in under-16s) to make sure your diet is giving you the nutrients you need
• a bone density assessment every 2 years – problems with digesting foods may affect your bone health
• a blood test for diabetes every 6 months
• an annual check for pancreatic cancer if the cause of chronic pancreatitis is hereditary

Page last reviewed: 26 May 2022
Next review due: 26 May 2025

Medications for the Treatment of Chronic Pancreatitis

Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.

Published on June 23, 2022

Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT).

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The pancreas is an organ that’s found behind the stomach. It produces enzymes and hormones that are needed for digestion. The pancreas can become inflamed from illness or injury, which is called pancreatitis . When this inflammation goes on for a long time, it’s called chronic pancreatitis.

This article will discuss some of the available treatment options for chronic pancreatitis, including supplements, pain management medications, endoscopy procedures, and surgery.

Chronic Pancreatitis Medications

Medications may be given to treat chronic pancreatitis. Antioxidants, pancreatic enzymes, and pain medications might be used to help manage symptoms.

Antioxidants and Pancreatic Enzymes

When the pancreas is inflamed, it might not be producing enough of the enzymes that are needed for digestion. This can cause digestive symptoms such as abdominal (stomach) pain, bloating, diarrhea, fatty stools (steatorrhea), intestinal gas, and weight loss.

A combination of pancreatic enzymes and various antioxidants might be the first treatment that’s tried. These medications could help reduce pain for as many as 50% of people who have chronic pancreatitis.

The antioxidants that have been studied in trials for chronic pancreatitis include ascorbic acid, beta-carotene, alpha-tocopherol, selenium, and methionine. These may be given in combination with other medications to control pain.

Pancreatic enzymes are given by prescription. They are used to replace the enzymes that the inflamed pancreas isn’t making or isn’t making in high enough amounts. They are taken at meal time and can help reduce the digestive symptoms that may go along with pancreatitis.

Pain Medications

Chronic pancreatitis may cause chronic abdominal pain. One type of drug that may be used to relieve the pain is nonsteroidal anti-inflammatory drugs (NSAIDs), which includes Voltaren (diclofenac), Advil or Motrin (ibuprofen), and Aleve (naproxen). These medications may also work to reduce the inflammation in the pancreas.

Another drug that may be prescribed for pain is Lyrica (pregabalin). This drug controls pain by having an effect on the central nervous system. In one study, the combination of antioxidants and Lyrica helped reduce the pain for 50% of people.

Common Side Effects of Chronic Pancreatitis Medications

Lyrica was approved in 2004 and can be prescribed in adults and children over the age of 4. It’s not recommended for use in people who are pregnant or breastfeeding.

Some of the most common side effects are:

• Blurred vision
• Difficulty with concentration or paying attention
• Dizziness
• Dry mouth
• Edema (swelling)
• Sleepiness or drowsiness
• Weight gain

NSAIDs are available over the counter and as a prescription. The use of NSAIDs long term may come with some risks. «Long-term use» is loosely defined as taking these medications at least three times a week for a period of about three months. The risks with NSAIDs are thought to increase as a person gets older.

Some of the potential side effects of NSAIDs include:

• Bleeding in the gastrointestinal (GI) tract
• Increased bruising
• Increased risk of stroke (caused by lack of blood flow to the brain due to blocked or burst arteries), heart attack, and blood clots
• Kidney damage
• Stomach irritation and ulcers (open sores in the stomach)
• Worsening symptoms of asthma (a condition that inflames, swells, and narrows the airways, making breathing difficult)

For the most part, antioxidants are safe to take long term. However, they may have adverse effects if they are taken in amounts that could be toxic. It’s important to follow instructions from a healthcare provider when supplementing with antioxidants in order to avoid any side effects.

Other Treatment Options

Most of the time, chronic pancreatitis is first treated with medications. However, there are endoscopic procedures and surgical techniques that might also be used to treat some people with chronic pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure that may be needed in chronic pancreatitis if there is a blockage or if there’s a suspected blockage.

During this procedure, a thin tube is inserted into the mouth and passed down through the esophagus, the stomach, and all the way into the first section of the small intestine.

A catheter is then threaded through the endoscope and into the bile ducts and pancreatic ducts to see if there are any abnormalities. Dye is also sent down through the endoscope, and then X-rays are taken.

Biopsies (small pieces of tissue that are removed and sent to a lab for testing) may also be performed. If there is a blockage in a bile duct or pancreatic duct, it might be possible to remove the blockage or place a stent to treat it.

Surgery is also sometimes used for chronic pancreatitis. Pancreatitis can be associated with stones in the pancreatic bile ducts. These stones can block the pancreatic ducts and prevent the pancreatic juices from traveling through. When that happens, it might be decided to do surgery or an ERCP to take out the stones and improve drainage.

If surgery is determined to be the best option, it can take different forms. It could mean removing part or all of the pancreas. It could also mean removing part or all of some other organs and structures such as bile ducts, gallbladder, stomach, or small intestine.

These operations can be complex and will need to be done by a specialist team. After surgery, the person will need to learn how to live without some or parts of these digestive organs. That could mean taking medications or supplements and going back to a healthcare provider for regular checkups.

Nutrition and Diet

A part of treating chronic pancreatitis is lifestyle changes and nutrition management. Working with a dietitian may help you get enough vitamins and nutrients to avoid malnutrition from food not being digested properly.

Quitting smoking and avoiding alcohol are other ways to manage chronic pancreatitis and lessen its symptoms.

Is Chronic Pancreatitis Curable?

Unfortunately, there is not a cure for chronic pancreatitis. It’s more accurate to say that this condition is manageable. However, there are good treatment options that can help get the pain and other symptoms of pancreatitis under control.

Summary

Chronic pancreatitis can cause pain and digestive symptoms. Treatments can include nutritional management, supplementing with pancreatic enzymes and antioxidants, pain management, and, in some cases, endoscopy procedures or surgery.

A Word From Verywell

Living with chronic pancreatitis is challenging. It’s important to get the physical aspects of this condition under control. However, coping with pain and the uncertainty of dealing with a chronic condition is also part of living with it.

Talk to your healthcare providers about resources such as support groups with others with the condition, mental health resources, patient advocacy groups, and social workers who can help you navigate this journey.

Frequently Asked Questions

What is the best pain medication for pancreatitis?

The best pain medication is one that’s going to help you improve your quality of life. It’s recommended that people with chronic pancreatitis first try Tylenol (acetaminophen) or NSAIDs to manage their pain. However, there are other options available, including Lyrica and even opioids. There are benefits and drawbacks to all of these medications. It may take some trial and error to find the pain medications that work best but also don’t cause concerning side effects or put you at a higher risk of other complications.

Is chronic pancreatitis curable?

There is currently no cure for chronic pancreatitis. However, people can expect to live many years after their symptoms start. The key is to work closely with healthcare providers in order to get the right treatments and manage pain and symptoms better.

How long can you live with chronic pancreatitis?

It’s estimated that most people with chronic pancreatitis will live for 15–20 years after being diagnosed. However, one study showed that 83% of people lived 35 years after their symptoms began. The prognosis for people living with chronic pancreatitis is improving as the disease is better understood and as more treatments become available.

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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Additional Reading

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.