TREATMENT OF PAIN IN CHRONIC-PANCREATITIS BY INHIBITION OF PANCREATIC-SECRETION WITH OCTREOTIDE

It has been suggested that pancreatic ductal hypertension, secondary t o pancreatic outflow obstruction, is a cause of pain in chronic pancre atitis. This study investigated the effect of inhibiting pancreatic se cretion with octreotide in chronic pancreatitis pain. Ten patients wit h chronic alcoholic pancreatitis and severe daily pain were included i n an intraindividual double blind crossover study. All patients receiv ed octreotide (3 X 100 mu g/day subcutaneously) and placebo (3 X 0.9% saline solution subcutaneously) for three days at random. Between both treatment phases a two day washout period was interposed. Intensity o f pain (visual analogue scale) and analgesic consumption were carefull y registered. Pancreatic secretion was monitored daily by measuring fa ecal chymotrypsin concentration. It was found that during the administ ration of octreotide, pancreatic secretion was strongly inhibited (fae cal chymotrypsin mean (SD) 1.7 (0.6) U/g) with respect to placebo (9.6 (4.2) U/g) and washout (7.6 (3.1) U/g) periods (p < 0.001). Pain scor e (29.6 (4.5) v 28.7 (5.8)) and consumption of analgesics were no diff erent during the octreotide and placebo periods. It is concluded that short term inhibition of pancreatic secretion does not result in pain relief in patients with chronic pancreatitis. This finding is in contr ast with the hypothesis that outflow obstruction of pancreatic secreti on with consequent ductal hypertension is an important cause of severe persistent pain in chronic pancreatitis.