CHRONIC PANCREATITIS AND DIABETES: PAIN MANAGEMENT, CLINICAL COMPLICATIONS AND SURGICAL POSSIBILITIES

Abstract

Introduction: Chronic pancreatitis, a persistent inflammation of the pancreas, often progresses to progressive loss of the organ's exocrine and endocrine function. Endocrine dysfunction, characterized by diabetes mellitus, is a common complication and significantly impacts the quality of life of patients. Clinical management of chronic pancreatitis involves pain control, enzyme replacement, and diabetes treatment. However, disease progression may require surgical interventions. This summary presents a systematic review of the literature on the relationship between chronic pancreatitis and diabetes, addressing pain management, clinical complications, and surgical possibilities. Objective: The review aimed to identify and synthesize the available scientific evidence on pain management, clinical complications, and surgical possibilities in patients with chronic pancreatitis and diabetes, with the aim of providing support for clinical practice and future research. Methodology: A systematic review of the literature was performed, following the recommendations of the PRISMA statement. The PubMed, Scielo and Web of Science databases were used to search for articles published in the last 10 years. The descriptors used were: chronic pancreatitis, diabetes mellitus, chronic pain, complications, surgical treatment. Original studies, systematic reviews and meta-analyses that addressed the relationship between chronic pancreatitis and diabetes, pain management and clinical complications were included. Studies with inadequate methodological design, narrative reviews and studies focusing on other diseases were excluded. Results: The results of the review demonstrated that chronic pain is a disabling symptom for patients with chronic pancreatitis, being often refractory to conventional treatments. Pain is associated with a worse quality of life and can lead to depression and anxiety. Clinical complications of chronic pancreatitis include malabsorption, steatorrhea, pancreatic pseudocyst and diabetes mellitus. Diabetes mellitus, in turn, aggravates the complications of chronic pancreatitis and increases the risk of cardiovascular events. Surgical treatment of chronic pancreatitis may be indicated in selected cases, such as in the presence of symptomatic pseudocysts or in cases of refractory pain. Surgical options include drainage of pseudocysts, pancreatic resection, and bypass surgery. Conclusion: Chronic pancreatitis and diabetes mellitus are complex chronic diseases that often coexist. The clinical management of these patients is challenging and requires a multidisciplinary approach. Chronic pain is a disabling symptom that significantly impacts the quality of life of patients. Clinical complications of chronic pancreatitis can be severe and lead to morbidity and mortality. Surgical treatment may be a therapeutic option in selected cases, but results can be variable and the decision to indicate surgery should be individualized. More research is needed to better understand the pathophysiology of chronic pancreatitis and to develop new therapies for the control of pain and complications.