• Mária Földi, Noémi Gede, Szabolcs Kiss, Áron Vincze, Judit Bajor, Imre Szabó, Zoltán Szepes, Ferenc Izbéki, Judit Gervain, József Hamvas, Zsuzsanna Vitális, Eszter Fehér, Stefan Crai, Ville Sallinen, Elena Ramirez-Maldonado, Ágnes Meczker, Péter Varjú, Goran Poropat, Davor Stimac, Nándor Faluhelyi, Attila Miseta, Tamás Nagy, Zsolt Márton, András Vereczkei, Jenő HegyiPéterPInstitute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.Center for Translational Medicine, Semmelweis University, Budapest, Hungary., Andrea Párniczky, Péter Hegyi, Andrea Szentesi, and Hungarian Pancreatic Study Group.
• Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary.
• Eur J Pain. 2022 Mar 1; 26 (3): 610-623.

IntroductionPain is the most common symptom in acute pancreatitis (AP) and is among the diagnostic criteria. Therefore, we aimed to characterize acute abdominal pain in AP.MethodsThe Hungarian Pancreatic Study Group prospectively collected multicentre clinical data on 1435 adult AP patients between 2012 and 2017. Pain was characterized by its intensity (mild or intense), duration prior to admission (hours), localization (nine regions of the abdomen) and type (sharp, dull or cramping).Results97.3% of patients (n = 1394) had pain on admission. Of the initial population with acute abdominal pain, 727 patients answered questions about pain intensity, 1148 about pain type, 1134 about pain localization and 1202 about pain duration. Pain was mostly intense (70%, n = 511/727), characterized by cramping (61%, n = 705/1148), mostly starting less than 24 h prior to admission (56.7%, n = 682/1202). Interestingly, 50.9% of the patients (n = 577/1134) had atypical pain, which means pain other than epigastric or belt-like upper abdominal pain. We observed a higher proportion of peripancreatic fluid collection (19.5% vs. 11.0%; p = 0.009) and oedematous pancreas (8.4% vs. 3.1%; p = 0.016) with intense pain. Sharp pain was associated with AP severity (OR = 2.481 95% CI: 1.550-3.969) and increased mortality (OR = 2.263, 95% CI: 1.199-4.059) compared to other types. Longstanding pain (>72 h) on admission was not associated with outcomes. Pain characteristics showed little association with the patient's baseline characteristics.ConclusionA comprehensive patient interview should include questions about pain characteristics, including pain type. Patients with sharp and intense pain might need special monitoring and tailored pain management.SignificanceAcute abdominal pain is the leading presenting symptom in acute pancreatitis; however, we currently lack specific guidelines for pain assessment and management. In our cohort analysis, intense and sharp pain on admission was associated with higher odds for severe AP and several systemic and local complications. Therefore, a comprehensive patient interview should include questions about pain characteristics and patients with intense and sharp pain might need closer monitoring.© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.

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