Finding Innovative Ways to Treat Pain from Pancreatitis
APRIL 01, 2016
Enhancing Quality of Life for Chronic Patients
Pancreatitis is an inflammation of the pancreas that causes digestive enzymes to attack and damage surrounding tissues. With chronic pancreatitis, the inflammation does not heal, worsens over time, and can lead to permanent damage, severe pain and pancreatic insufficiency. Its primary symptom is upper abdominal pain that can get worse after eating.
Pancreatitis is the most common reason for gastrointestinal-related hospitalization, and strikes young and old alike.
"Contrary to popular belief, only a small subset of pancreatitis cases are related to heavy alcohol use. It is not just a disease of alcoholics," says Steven D. Freedman, MD, PhD, Director of the Pancreas Center at the Digestive Disease Center and Chief of the Translational Research division at Beth Israel Deaconess Medical Center (BIDMC). "In many patients, including young children, the cause of the inflammation is unexplained."
Chronic pancreatitis can be difficult to diagnose because CT scans, MRIs, ultrasounds and standard blood tests often show normal results for three to four years, despite the presence of the disease. The BIDMC Pancreas Center is one of only a few centers in the world that performs specially-modified endoscopic secretin pancreatic function testing, a highly sensitive test that can diagnose pancreatitis up to three years before changes can be seen on radiologic imaging tests.
"This test actually looks at how the pancreas is functioning, as opposed to imaging tests that show only structural abnormalities," Freedman says.
Clinical Trials Give Access to Novel Treatments
Conventional treatment for pancreatitis includes narcotic medications for pain, parenteral nutrition (intravenous feeding) to bypass the digestive process, and surgery when indicated. Freedman, his team and a multidisciplinary group of specialists at BIDMC are working to expand the tools available in their arsenal of chronic pancreatitis diagnostic and treatment options.
"Because the main symptom of chronic pancreatitis is chronic pain, finding ways to remove or minimize pain is a major goal," says Freedman.
In another revolutionary study, Freedman teamed up with Alvaro Pascual-Leone MD, PhD, Chief of the Division of Cognitive Neurology and Director of the Berenson-Allen Center for Noninvasive Brain Stimulation at BIDMC, focusing on the site in the brain that signals pancreas pain.
Clinical trials in which transcranial magnetic stimulation (TMS) — a noninvasive magnetic beam — was applied over that area of the scalp resulted in 70 percent of patients achieving significant reduction in their pain.
"The results indicate that we may have a way to diminish the pain noninvasively and without the use of narcotics," Freedman notes.
The Pancreas Center is currently enrolling patients in another clinical trial in collaboration with Spaulding Rehabilitation Hospital using transcranial direct current stimulation (tDCS) — a simpler form of TMS — combined with meditation.
Every Great Team Needs a Great Quarterback
"We act as the quarterback for every patient, planning and coordinating their care with them and making sure they have access to every possible option to enhance their quality of life," says Freedman.
Patients new to the Pancreas Center are seen within one week, and initial office visits generally last up to 90 minutes. In addition to documenting the medical history and physical exam findings, Freedman maps out a patient's presenting problems, details all of the possible causes, discusses how tests or treatments ordered may change the management plan, relays what he and his multidisciplinary team will do to make them better, and stays in touch every one to two weeks until symptoms have improved.
"Not a lot of other centers do this," says Freedman. "Your health is a priority, but it's hard to navigate the medical field, especially when multiple specialists are involved. Whether it is you or a loved one who is ill, whether it is a chronic illness or not, you need to know that everything that needs to be done is being done. I am happy to be a resource."