Pancreatic pain can be caused by a number of conditions affecting the pancreas, an organ that plays an important role in digestion. Some causes of pancreatic pain, like pancreatitis or pancreatic cancer, may come and go, while others result in more persistent pain. Understanding the nature of pancreatic pain can help identify potentially serious pancreatic conditions.
What is the pancreas?
The pancreas is an organ located behind the stomach that is part of both the digestive and endocrine systems in the body. It has two main functions:
- Producing enzymes that help digest fats, proteins, and carbs
- Producing hormones like insulin that regulate blood sugar levels
The pancreas contains clusters of cells known as acini that produce digestive enzymes. These enzymes are transported via ducts into the first part of the small intestine. The pancreas also contains clusters of hormone-producing cells known as islets of Langerhans.
What causes pancreatic pain?
Pain arising from the pancreas is called pancreatic pain or pancreatogenic pain. Several conditions can lead to pancreatic pain, including:
- Acute pancreatitis: Inflammation of the pancreas, often caused by gallstones or heavy alcohol use
- Chronic pancreatitis: Ongoing inflammation that destroys pancreatic tissue over time, often due to heavy alcohol use
- Pancreatic cancer: Cancerous growth in pancreatic tissue, usually arising from the cells lining the ducts
- Pancreatic cysts or tumors: Fluid-filled sacs or abnormal tissue growths that can compress the pancreas
- Gallstones: Stones blocking the bile duct, which can obstruct outflow from the pancreas
In many cases, the pancreatic pain stems from inflammation, which can irritate nerves in and around the pancreas. Pressure from swollen tissue, cysts, tumors, or stones can also trigger pancreatic pain signals.
Does pancreatic pain come and go?
Whether pancreatic pain comes and goes depends on the underlying cause:
Acute pancreatitis
Acute pancreatitis often causes severe abdominal pain that comes on quickly and fluctuates in intensity. The pain can:
- Feel sharp, stabbing, or cramping
- Start in the upper abdomen and radiate to the back
- Come and go as attacks occur, lasting hours or days
- Be accompanied by nausea, vomiting, fever, and an elevated heart rate
The pain may subside for a time between attacks. Mild cases resolve on their own, while severe cases require hospitalization.
Chronic pancreatitis
In chronic pancreatitis, recurrent inflammation and damage to the pancreas leads to more persistent pain that may:
- Range from mild discomfort to severe pain
- Feel like a dull ache or burning sensation in the upper abdomen
- Spread to the back, sides, or below the left shoulder blade
- Come and go but be present most of the time
- Get worse after eating, especially foods high in fat
Pain may fluctuate in severity but is often chronic. Attacks of acute inflammation on top of the chronic condition can also occur.
Pancreatic cancer
Pancreatic cancer often does not cause symptoms until it is advanced. When pain does occur, it may:
- Be mild to severe
- Feel like dull, constant pain in the upper abdomen radiating to the back
- Come and go at first, becoming persistent as the tumor grows
- Worsen with eating or lying down
As the tumor enlarges, it can press on nerves and organs, leading to increasing pain. Blockage of bile or pancreatic ducts can also cause episodes of intense pain.
Pancreatic cysts and tumors
Cysts and non-cancerous tumors in the pancreas may grow large enough to cause pain that:
- Is dull and achy
- Comes and goes at first
- Becomes constant as the mass gets larger
These growths can eventually obstruct ducts or press on surrounding organs, nerves, and blood vessels, resulting in worsening pain.
Gallstones
If gallstones pass from the gallbladder into the bile duct, they can get lodged blocking the outflow from the pancreas, causing:
- Sudden, severe pain in the upper abdomen that may radiate to the back
- Nausea, vomiting, fever, and chills
- Pain that comes and goes as gallstones intermittent block the duct
This obstruction leads to backup and inflammation of the pancreas, resulting in intermittent pain attacks.
When to seek medical care for pancreatic pain
It is important to seek prompt medical attention for any unexplained or severe abdominal pain, especially if accompanied by concerning symptoms like:
- Nausea and vomiting
- Fever or chills
- Jaundice (yellowing skin/eyes)
- Oily stools
- Blood glucose fluctuations
- Unintended weight loss
Persistent or worsening abdominal pain should also be evaluated quickly. Early diagnosis of conditions like chronic pancreatitis or pancreatic cancer can improve outcomes.
Seeking urgent care or an emergency room evaluation is advised for:
- Sudden, severe abdominal pain
- Inability to keep down fluids
- Signs of shock like rapid heart rate, confusion, or fainting
These can indicate a serious condition like acute pancreatitis, perforated ulcer, bowel obstruction, or ruptured aneurysm requiring rapid treatment.
How is pancreatic pain diagnosed?
To determine the cause of pancreatic pain, doctors use:
Medical history and physical exam
Information about symptoms, risk factors, and exam findings helps narrow down differential diagnoses. Palpating the abdomen to check for tenderness aids evaluation.
Blood tests
Blood tests check for elevated levels of pancreatic enzymes like amylase and lipase indicating injury to the pancreas. Other lab tests help assess liver function, nutrition, and glucose control.
Imaging studies
Imaging like ultrasound, CT, or MRI scans create pictures of the pancreas and surrounding structures to identify:
- Pancreatitis
- Stones in the bile or pancreatic ducts
- Pseudocysts, tumors, or cancers
- Blockages of the ducts
Endoscopic ultrasound
This technique uses an endoscope passed down the throat into the stomach and duodenum. This allows the pancreas to be visualized in detail using high-frequency sound waves.
ERCP
Endoscopic retrograde cholangiopancreatography (ERCP) involves passing a scope through the stomach into the bile and pancreatic ducts. Contrast dye is injected to highlight these ducts on x-rays. It also allows treatment like stone removal.
Biopsy
Removing a small tissue sample for examination under a microscope can help confirm cancers or other conditions.
What are the treatment options for pancreatic pain?
Treatment of pancreatic pain involves:
Treating the underlying condition
This can include:
- Fasting and IV fluids for acute pancreatitis
- Surgery to remove gallstones blocking ducts
- Drainage of pseudocysts
- Chemotherapy or radiation to treat cancers
- Enzyme supplements for chronic pancreatitis
Relieving the cause can allow pancreatic inflammation and pain to subside.
Pain management
Options to help relieve pain include:
- OTC pain relievers like acetaminophen
- Prescription narcotics for short-term use
- Adjuvant drugs like antidepressants or anticonvulsants
- Celiac plexus block injection for chronic pain
Doctors try to minimize narcotic use due to risks of tolerance and dependence.
Dietary changes
A low-fat diet and eating smaller, frequent meals can sometimes decrease pain episodes associated with pancreatitis.
Surgery
For chronic pancreatitis, removing part of the pancreas or draining an obstructed duct may relieve persistent pain.
Alternative therapies
Options like meditation, massage, or acupuncture may aid in pain control for some individuals.
What is the outlook for pancreatic pain?
The prognosis for pancreatic pain varies:
- Mild acute pancreatitis often resolves in a few days with conservative measures.
- Severe acute pancreatitis has a mortality rate around 10-30% even with treatment.
- Chronic pancreatitis is a progressive disease leading to irreversible damage and disability.
- Pancreatic cancer survival is only around 10% at 5 years even with treatment.
- Benign pancreatic cysts and tumors have good outcomes if surgically removed.
Early diagnosis and proper management is key to optimizing outcomes in any pancreatic disorder. Ongoing care is needed for chronic conditions causing persistent pancreatic pain and associated complications.
Conclusion
In summary, whether pancreatic pain comes and goes depends largely on the specific condition involved:
- Acute pancreatitis causes severe attacks of pain that resolve between episodes.
- Chronic pancreatitis leads to more constant daily pain often punctuated by acute flare-ups.
- Pancreatic cancers cause pain that is initially intermittent but becomes persistent with tumor growth.
- Cysts and tumors result in fluctuating pain that worsens as they enlarge.
- Obstructive gallstones cause intermittent pain when passing through and blocking the bile duct.
Proper diagnosis using history, exams, blood tests, and imaging can identify these treatable sources of pancreatic pain. Even when due to chronic diseases like pancreatitis or cancer, carefully managing pain can still provide symptomatic relief and improved quality of life.