Pain mechanisms of pancreatic diseases

By | April 2, 2012

Pancreatic invasion or spread directly into the pancreas of the nerves, leading to neuronal pain sensitization. Pancreatic ductal carcinoma is slightly different, because this new bio-neural solution can be expressed and secreted enzymes, the tumor along a nerve Ju invasion and expansion, more specific. Selective neural invasion increased the nerve stimulation. Easily transferred to a small number of cases of pancreatic cancer near the solar plexus of the retroperitoneal lymph nodes.
Expansion and transfer of lymph node along the neural invasion and expansion, can also cause nerve pain sensitization. Limitation of pancreatic cancer can also induce pancreatitis, the pain mechanisms involved in the formation of pancreatic diseases. The results, with inflammation of the pancreas to chemical and mechanical nerve stimulation has become more sensitive. Chronic pancreatitis (non-pancreatic) tissue surrounding nerve cells showed a large number of eosinophil infiltration. The limitations of the inflammation, loss of peripheral nerve Ju variety of toxic substances can lead to stimulation of sensitized neurons, including prostaglandins, bradykinin peptides, acidosis, glue and other toxic substances group. Have found that pancreatitis nerve afferent neurotransmitter is increased.
Theory of pain mechanisms of pancreatic diseases, increased interstitial pressure catheter pressure and pain can also cause pancreatitis, this mechanism can also be found in the pancreatic cancer cases. First, chronic pancreatitis showed abnormally high pressure within the duct. Chronic pancreatitis and pancreatic cancer sensitized afferent toxic substances may be sensitive to mechanical stimulation, an increase in pressure occurs when the pancreas.
In addition, surgical decompression and drainage can make 70% r – 80% improvement in cases of pancreatic pain. Second, the increase of pressure within the pancreatic pain in pancreatic disease, in determining the fiber capsule of the pancreas to increase the pressure chamber can cause syndrome. The latter will increase vascular resistance, decreased blood flow lead to further increases to nerve stimulation and the formation of ischemic pain.
The mechanism of pancreatic diseases by the repetition of the visceral pain afferent stimulation can cause central nervous system sensitivity to pain stimuli condition. Inflammatory tissue damage by activation of visceral or visceral pain receptors quiet the introduction of increased spinal cord. Repetitive stimulation of peripheral nerve endings increases the sensitivity of the peripheral nerves, the stimulation threshold value decreased, thereby prolonging and enhancing the response to stimuli. Increased sensitivity to the results of spinal cord is an increase of neurotransmitter release tension, excitement may change the activity of neurons in the spinal cord.
Nerve center of the level, the more active neurons, and lead to the increase in width of the peripheral nerve feeling, that feeling of an area, the pain. Tissue injury or by the stimulation, the central sensitization state of peripheral nerve pain can cause the expansion of the input, the original can feel normal or physiological state, width of the value of the results of the patients decreased pain, increased response to painful stimuli, resulting in pain perception valve expanded.
Pain in chronic pancreatitis and pancreatic cancer, the first step is often used class of anti-inflammatory drugs relieve pain of non-simplified, but often need to increase in order to enhance the effect of opioids. Opioid painkillers can inhibit the pain, but with side effects, impact on patient quality of life. One study evaluated the opioid effect on pain relief, the most common side effects are dry mouth (39% during follow-up days), feeling sleepy (38%), constipation (35%), nausea and vomiting (22% ), no obvious side effects were only 22% of cases.
Pain in pancreatic disease mechanism, In addition, there is a growing evidence that prolonged high-dose opioids can suppress the immune function, including inhibition of natural killer cell function, these functions have to kill tumor cells and inhibit tumor growth. Randomized double-blind placebo-controlled trial, Lillemoe and other celiac plexus block of surgical treatment of pancreatic cancer pain treatment before surgery in patients with CPN, the quality of their survival was significantly better than the control group. Speculated that effective control of pain can improve the nutritional status and emotional status, body mass index increased survival. Narcotic analgesic drug dependence is the complications of chronic pancreatitis, often making treatment failure. Therefore, chronic pancreatitis and pancreatic cancer treatment of non-drug pain relief can increase survival time and improve quality of life.

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