Pancreatitis, chronic - Treating chronic pancreatitis

There is no cure for chronic pancreatitis, but treatment can help control the condition and reduce any symptoms.

Lifestyle changes

If you are diagnosed with chronic pancreatitis, some lifestyle changes will be recommended. These are described below.

Avoiding alcohol

The most important thing you can do is stop drinking alcohol, even if this is not the cause of your condition. This will help prevent further damage to your pancreas and may help to reduce the pain.

If you continue to drink alcohol, it is likely you will experience debilitating pain and you will be more likely to die from a complication of chronic pancreatitis.

Some people with chronic pancreatitis caused by alcohol consumption have a dependency on alcohol and require additional help and support to stop drinking. If this applies to you, talk to your GP about getting help to stop drinking.

Treatment options for alcohol dependence include:

one-to-one counselling
self-help groups, such as Alcoholics Anonymous
a medication called acamprosate that can help reduce cravings for alcohol

Read more about treating alcohol misuse.

Stopping smoking

If you smoke, you should stop. Smoking can speed up the progress of chronic pancreatitis, making it more likely that your pancreas will lose its function.

It's recommended that you use an anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes). People who use these types of treatments have a much greater success rate in permanently stopping smoking than those who try to quit using willpower alone.

If you want to give up smoking, it is a good idea to start by visiting your GP. They will be able to provide you with help and advice about quitting and can refer you to an NHS Stop Smoking support service.

These services offer the best support for people who want to give up smoking. Studies show that you are four times more likely to give up smoking if you do it through the NHS. For more information, you can call the NHS Stop Smoking helpline on 0800 022 4332 (England only).

Dietary changes

As chronic pancreatitis can affect your ability to digest certain foods, you may need to change your diet. In particular, a low-fat diet is recommended.

Your GP may be able to provide you with appropriate dietary advice, or may refer you to a dietitian, who will draw up a suitable dietary plan.

Enzyme supplements

You may be given pancreatic enzyme supplements, medication that contains an artificial version of the enzymes (chemicals) produced by your pancreas. These supplements may help improve the effectiveness of your digestive system.

Side effects of pancreatic enzyme supplements can include diarrhoea, constipation, nausea, vomiting, and stomach pains.

If you do experience side effects that are particularly troublesome, talk to your GP, as your dosage may need to be adjusted.

Steroid medication

If you have chronic pancreatitis caused by problems with your immune system, treatment is relatively straightforward. The inflammation affecting the pancreas can usually be relieved using steroid medication (corticosteroids).

However, taking corticosteroids for a long time can cause troublesome side effects, such as osteoporosis (weakening of the bones) and weight gain.

Pain relief

Pain relief is an important part of the treatment of chronic pancreatitis. At first, mild painkillers will be used, but more powerful ones will be needed if these do not work.

Mild painkillers

In most cases, the first painkiller used is paracetamol or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen.

Taking NSAIDs on a long-term basis can increase your risk of developing stomach ulcers, so you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect against this.

Stronger painkillers

If NSAIDs or paracetamol prove to be ineffective in controlling your pain, it is likely you will need an opiate-based painkiller, such as codeine or tramadol. Side effects of these types of medication can include constipation, nausea, vomiting and drowsiness.

The side effect of constipation can be particularly troublesome if you need to take an opiate-based painkiller on a long-term basis. In such circumstances, you may be prescribed a laxative to help relieve your constipation. See treating constipation for more information.

If you feel drowsy after taking an opiate-based painkiller, you should avoid driving and using heavy tools or machines.

Severe pain

If you experience an attack of very severe pain, you may need a stronger opiate-based painkiller, such as morphine or pethidine. These have similar side effects to the opiate-based painkillers mentioned above.

Long-term use of these stronger opiate-based painkillers is not usually recommended because there is a high risk of addiction. Therefore, if you have persistent severe pain, surgery will usually be recommended.

In some cases, an additional medication called amitriptyline may be recommended. Amitriptyline was originally designed to treat depression, but it can help to relieve pain in some people.

If medication is ineffective, severe pain can sometimes be temporarily relieved for a few weeks or months using a procedure called a nerve block. This is an injection that blocks the pain signals from the pancreas.

Surgery

Surgery can be used to treat severe pain in people with chronic pancreatitis. Depending on the exact cause of your pain, there are a variety of surgical techniques that may be used. Some of these are outlined below.

Endoscopic surgery

Patients with stones in the opening of their pancreas (the pancreatic duct) may benefit from endoscopic surgery and a treatment called lithotripsy.

Lithotripsy involves using shock waves to break the stone into smaller pieces. An endoscope (a thin, long, flexible tube with a light source and a video camera at one end) is then used to pass surgical instruments into the pancreatic duct so the pieces can be removed.

This treatment may improve pain to some extent, but the benefit may not be permanent.

Pancreas resection

In cases where specific parts of the pancreas are inflamed and causing severe pain, these parts can be surgically removed. This type of surgery is called a pancreas resection.

Pancreas resection can also be used if endoscopic treatment is ineffective.

The technique used for pancreas resection depends on exactly which parts need to be removed. For example, some techniques involve removing the gallbladder along with parts of the pancreas.

The different surgical techniques tend to have the same levels of effectiveness in terms of reducing pain and preserving the function of the pancreas, although some of the more complex techniques have an increased risk of complications, such as infection and internal bleeding. Simpler procedures have a lower risk of complications and usually have faster recovery times.

Discuss the pros and cons of the appropriate pancreas resection techniques with your surgical team before making a decision.

Total pancreatectomy

In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas. This is known as a total pancreatectomy.

A total pancreatectomy can be very effective in treating pain. However, you will no longer be able to produce the insulin that is needed by your body. To overcome this problem, a relatively new technique called autologous pancreatic islet cell transplantation (APICT) is sometimes used.

During APICT, the islet cells responsible for producing insulin are removed from your pancreas, before your pancreas is surgically removed.

The islet cells are mixed with a special solution, which is injected into your liver. If the APICT procedure is successful, the islet cells remain in your liver and begin to produce insulin.

In the short-term, APICT appears to be effective, but you may need additional insulin treatment in the long-term. See guidelines from the National Institute for Health and Care Excellence about autologous pancreatic islet cell transplantation for more information.