Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis

Mohamad Mokadem; Lama Noureddine; Thomas Howard; Lee McHenry; Stuart Sherman; Evan L Fogel; James L Watkins; Glen A Lehman

doi:10.3748/wjg.v22.i16.4160

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Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis

Journal article

Open access

Peer reviewed

Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis

Mohamad Mokadem, Lama Noureddine, Thomas Howard, Lee McHenry, Stuart Sherman, Evan L Fogel, James L Watkins and Glen A Lehman

World journal of gastroenterology : WJG, Vol.22(16), pp.4160-4167

04/28/2016

DOI: 10.3748/wjg.v22.i16.4160

PMCID: PMC4837433

PMID: 27122666

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https://doi.org/10.3748/wjg.v22.i16.4160View

Published (Version of record) Open Access

Abstract

To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump infusion. We recognized 13 patients who underwent intrathecal narcotic pump (ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation (TP + ICT) for chronic pancreatitis (CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians. All patients were evaluated retrospectively using a questionnaire inquiring about their pain control (using a 0-10 pain scale), daily narcotic dose usage, and hospital admission days for pain control before each intervention and during their last follow-up. All 13 ITNP patients and 30 available TP + ICT patients were evaluated. The mean age was approximately 40 years in both groups. The median duration of pain before intervention was 6 years and 7 years in the ITNP and TP + ICT groups, respectively. The median pain score dropped from 8 to 2.5 (on a scale of 0-10) in both groups on their last follow up. The median daily dose of narcotics also decreased from 393 mg equivalent of morphine sulfate to 8 mg in the ITNP group and from 300 mg to 40 mg in the TP + ICT group. No patient had diabetes mellitus (DM) before either procedure whereas 85% of those who underwent pancreatectomy were insulin dependent on their last evaluation despite ICT. ITNP and TP + ICT are comparable for pain control in patients with CP however with high incidence of DM among those who underwent TP + ICT. Prospective comparative studies and longer follow up are needed to better define treatment outcomes.

Pain, Intractable - therapy

Indiana

Infusions, Spinal

Humans

Middle Aged

Pancreatitis, Chronic - diagnosis

Male

Narcotics - adverse effects

Pain, Intractable - diagnosis

Time Factors

Islets of Langerhans Transplantation - adverse effects

Adult

Diabetes Mellitus - etiology

Female

Surveys and Questionnaires

Retrospective Studies

Hypoglycemic Agents - therapeutic use

Pancreatectomy - adverse effects

Pain, Intractable - etiology

Infusion Pumps, Implantable

Diabetes Mellitus - drug therapy

Hospitals, University

Treatment Outcome

Narcotics - administration & dosage

Pancreatitis, Chronic - complications

Pancreatitis, Chronic - therapy

Pain Measurement

Morphine - administration & dosage

Insulin - therapeutic use

Morphine - adverse effects

Details

Title: Subtitle: Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis
Creators: Mohamad Mokadem - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Lama Noureddine - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Thomas Howard - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Lee McHenry - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Stuart Sherman - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Evan L Fogel - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
James L Watkins - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Glen A Lehman - Mohamad Mokadem, Division of Gastroenterology and Hepatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA 52242, United States
Resource Type: Journal article
Publication Details: World journal of gastroenterology : WJG, Vol.22(16), pp.4160-4167
DOI: 10.3748/wjg.v22.i16.4160
PMID: 27122666
PMCID: PMC4837433
NLM abbreviation: World J Gastroenterol
ISSN: 1007-9327
eISSN: 2219-2840
Language: English
Date published: 04/28/2016
Academic Unit: Gastroenterology and Hepatology; Nephrology; Internal Medicine
Record Identifier: 9984094389202771

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