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The Pancreas Center works to find the optimal pain management regimen that enables each patient to remain active and at home rather than in the hospital or unable to maintain normal levels of activity.
Many patients take a regimen of more than one kind of medication. Oral medications include narcotics such as Percocet and oxycodone, and these may be used in conjunction with non-narcotic medicines such as muscle relaxants and antidepressants. Oral methadone is a very good medication for managing chronic pain.
Once an oral regimen is established, acute flare-ups can be managed by temporarily adding medications. If oral medicines can't be tolerated, patients may need to be admitted to the hospital for intravenous medications. Nerve blocks may be used to manage pain for several months at a time: nerve blocks entail the insertion of a needle through the skin in the back to block the signals of the main nerves going to the pancreas. This procedure can also be done endoscopically, in which the bundle of nerves to the pancreas is injected with long-acting pain medication that lasts several months. This is performed using an endoscope through the stomach. Nerve blocks destroy the nerves, but in time they grow back so patients need repeated treatments.
Another approach to managing pain is the use of implantable pain pumps in the spine. Most implantable pumps deliver constant low doses to keep pain manageable, and they may be used in conjunction with oral medications.
Importance of taking pain medications
Some patients express concern about not wanting to become addicted to pain medications. It is important to understand that severe ongoing pain needs to be addressed so that patients can maintain active lives, and a true need for pain medication does not constitute a psychological addiction. Some patients must always use medications, because chronic pancreatitis does not go away and the pain needs to be managed in order for them to function. When chronic pancreatitis is caused by microscopic inflammation of the pancreas, management of ongoing pain does not constitute a social addiction, but rather it is a needed therapy like taking blood pressure medication. Our team tries to use constellations of different medications in order to keep narcotic dosages as low as possible.