Re: pancreatic burn-out

August 29, 2002

Hi all,

re: pancreatic burnout .... as has been mentioned, this is a pretty

controversial subject. The pain management specialist who Karyn had

speak at the first 2 Pancreatitis Symposiums here in Indianapolis had

some interesting things to say about this. He mentioned that even

when patients reach that " end stage " when the pancreas completely

stops producing any/all digestive enzymes

(amylase, lipase, etc), patients often STILL experience constant

levels of pain. He explained that they believe this is due to the

fact that the pain nerve fibers around the pancreas have been so

conditioned to constantly firing, that they become

permanently " excited " , so that even when the original source of the

pain is removed (either through " burnout " or surgical intervention),

the base-level sensation of pain may never totally go away. Those

who have had various surgical interventions done may continue to

experience some pain due to the internal scar tissue as a result of

those procedures. He also made the analogy of " phantom pain " that

many amputee patients continue to experience. The pain is real,

because the remaining nerve fibers continue to fire and send signals

to the brain, which interprets them as the sensation of pain. The

hope is, however, that there should be few/no episodes of " break-

through " pain at that point - i.e., no more " accute " attacks, and the

base-level pain is easier to manage with the right combination of

pain meds. The various nerve block techniques may be more effective

at that point, but as many on this board have stated, those effects

are generally short-term, and must be repeated as the nervous system

re-generates itself. Several patients who have had the total

pancreatectomy performed (after years of chronic pancreatitis, and/or

one of more various surgical interventions) still report a continuous

(usually much lower) base-level pain. It's just much easier to

manage, and they aren't left with the rest of the " unpredictableness "

of the disease.

Of course, many patients who have had the pancreatectomy, which would

be equivalent to " burnout " , since in both cases, none of the enzymes

are being produced, experience absolutely NO pain (once they recover

from the surgery). As is true of everything else with this disease,

everyone's body responds differently, and it also seems to be related

to how long they had pancreatitis, and how severe the accute episodes

were, etc, before the surgery.

--Tull

Assistant Moderator

Pancreatitis Association, Int'l

> ,

>

> It sounds like you are at the same mental point as I am. I have

begun to

> believe that pancreatic burnout is the medical equivalent on an

Urban

> Myth. So far no one that I ask can name a single person that has

reached

> that point. I think it is a carrot the docs hang out in front of

us

> end-stagers so that we don't completely lose hope.

>

> Sounds like you might agree.

>

> Chuck

>

August 30, 2002

> Thank you!

> Now could you get me a name of one of the experts?

> Email will do and you can even email it to me!

> I am not asking for that much, the timing is critical during this.

If

> they are there, they will help me. I have sent out to the powers to

> be for help. Just guiding advice through this.

> Thanks,

Hi ,

I have just e-mailed you privately, but here is some more information

that may be of interest to all. The type of pain caused by " damaged "

or " permanently excited " nerver fibers is called " neuropathic pain " .

Diabetic neuropathy is one of the more common forms of this

condition. Here is a link to a rather lengthy, detailed article on

pain management that discusses this condition:

http://www.postgradmed.com/issues/1999/11_99/neuropathic.htm

.... and here is a short excerpt from that article:

" Automatic firing of damaged nerves

Nerve fibers that have been damaged by injury or disease can fire

spontaneously at the site of injury or at ectopic foci along the

damaged nerve. Resulting paroxysms of pain are often described as

lancinating, stabbing, or shooting. When many nerve fibers are

affected and fire asynchronously, neuropathic pain has a quality of

continuous burning. This process of automatic firing can last

indefinitely and represents one cause of persistent physiologic pain.

It also explains how pain can occur in a part of the body that is

numb (anesthesia dolorosa). When large-diameter fibers are damaged,

as in diabetic neuropathy, ectopic impulses can be generated in the

small-diameter fibers (C-fiber nociceptors) that carry pain

sensation. "

This should give you a good " jumping off point " for further research.

Good luck,

--Tull

tull@...

Assistant Moderator

Pancreatitis Association, Int'l

August 30, 2002