447: Pain management during a prolongues stay due to severe necrotizing pancreatitis: P�ncreas divisum

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute visceral pain, Pharmacological treatments, Treatment/management

Background and Aims: Jagannath et al. (2018) discuss how patients with non-biliary recurrent acute pancreatitis (RAP) are prone to developing chronic pancreatitis (CP), suggesting a continuum from acute to recurrent to chronic pancreatitis. The role of pancreas divisum, sphincter of Oddi dysfunction, and anomalous pancreatobiliary junction in causing RAP is controversial. (2)
Gurakar et al. 2022, Approximately three-quarters of patients with pancreas divisum present with a risk factor for pancreatitis. .(1)
Bouwense SA (2015) acknowledges that persistent pain can induce alterations in central pain processing, targeted treatment should be initiated to address these changes (e.g., gabapentinoids, ketamine, or tricyclic antidepressants).(3)

Methods: This is a clínical case retrospective, descriptive

Results: A 65 year old female patient, scientific, heavy smoker with recurrent pancreatitis en 3 months of hospitalization and 2 readmisiones to ICU, necrosis was 50%, On day 7 receiving 5 mg of morphine every 8 hours. Attempts to reduce dose were unsuccessful with breakthrough pain, it decided to prepare a continuous infusion pump 12 mg of morphine/24h and add an adjuvant (Gabapentin 300mg in title every 7 days until 1800mg and a prokinetic agent (levosulpiride 25mg/8h) morphine was rotation equivalent to buprenorfin patch descontinued after papillotomy and placement LAMS. She was discharged without opioids.

Conclusions: Early intervention is decisive, assessment of risk factors, and monitoring of opioid and gabapentinoid titration. During her hospitalization, the patient received an incidental diagnosis of lung cancer. Even so, the goal of preventing chronic pain and opioid-free.

References: 1. Gurakar M, Jalaly NY, Faghih M, Boortalary T, Azadi JR, Khashab MA, Fan C, Kalloo AN, Zaheer A, Singh VK, Afghani E. Impact of genetic testing and smoking on the distribution of risk factors in patients with recurrent acute and chronic pancreatitis. Scand J Gastroenterol. 2022 Jan;57(1):91-98.

2. Jagannath S, Garg PK. Recurrent Acute Pancreatitis: Current Concepts in the Diagnosis and Management. Curr Treat Options Gastroenterol. 2018 Dec;16(4):449-465.

3. Bouwense SA, de Vries M, Schreuder LT, Olesen SS, Frøkjær JB, Drewes AM, van Goor H, Wilder-Smith OH. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol. 2015 Jan 7;21(1):47-59.

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Presenting Author: Karina Vega Caldas
Submitting Author: Karina Vega

Senior Author: Karina Vega Caldas

IASP 2026 Global Year theme of Neuropathic Pain: Yes