Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Dhiraj Yadav; Robert L Askew; Tonya Palermo; Liang Li; Dana K Andersen; Minxing Chen; William E Fisher; Evan L Fogel; Christopher E Forsmark; Phil A Hart; Mohamed O Othman; Stephen J Pandol; Walter G Park; Mark D Topazian; Stephen K Van Den Eeden; Santhi Swaroop Vege; Yunlong Yang; Jose Serrano; Darwin L Conwell; Consortium for the Study of Chronic Pancreatitis, Diabetes; Pancreatic Cancer (CPDPC)

doi:10.1016/j.cgh.2022.09.026

Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Clin Gastroenterol Hepatol. 2023 Jul;21(7):1781-1791.e4. doi: 10.1016/j.cgh.2022.09.026. Epub 2022 Oct 1.

Authors

Dhiraj Yadav¹, Robert L Askew², Tonya Palermo³, Liang Li⁴, Dana K Andersen⁵, Minxing Chen⁴, William E Fisher⁶, Evan L Fogel⁷, Christopher E Forsmark⁸, Phil A Hart⁹, Mohamed O Othman¹⁰, Stephen J Pandol¹¹, Walter G Park¹², Mark D Topazian¹³, Stephen K Van Den Eeden¹⁴, Santhi Swaroop Vege¹³, Yunlong Yang⁴, Jose Serrano⁹, Darwin L Conwell⁹; Consortium for the Study of Chronic Pancreatitis, Diabetes; Pancreatic Cancer (CPDPC)

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: yadavd@upmc.edu.
² Department of Psychology, Stetson University, DeLand, Florida.
³ Department of Anesthesiology, University of Washington, Seattle, Washington.
⁴ Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
⁵ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
⁶ Division of General Surgery, Baylor College of Medicine, Houston, Texas.
⁷ Digestive and Liver Disorders, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
⁸ Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida.
⁹ Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio.
¹⁰ Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.
¹¹ Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California.
¹² Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
¹³ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
¹⁴ Division of Research, Kaiser Permanente Northern California, Oakland, California.

Abstract

Background and aims: Pain is a cardinal symptom of chronic pancreatitis (CP). Using Patient-Reported Outcomes Measurement Information System (PROMIS) measures, we characterized physical and mental health and symptom profiles of a well-defined cohort of individuals with CP and compared them with control subjects. Among patients with CP, we also examined associations between pain (intensity, temporal nature) and PROMIS symptom profiles and the prevalence of clinically significant psychological comorbidities.

Methods: We analyzed baseline data in 488 CP patients and 254 control subjects enrolled in PROCEED (Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies), an ongoing longitudinal cohort study. Participants completed the PROMIS-Global Health, which captures global physical and mental health, and the PROMIS-29 profile, which captures 7 symptom domains. Self-reported pain was categorized by severity (none, mild-moderate, severe) and temporal nature (none, intermittent, constant). Demographic and clinical data were obtained from the PROCEED database.

Results: Pain was significantly associated with impairments in physical and mental health. Compared with participants with no pain, CP participants with severe pain (but not mild-moderate pain) had more decrements in each PROMIS domain in multivariable models (effect sizes, 2.54-7.03) and had a higher prevalence of clinically significant depression, anxiety, sleep disturbance, and physical disability (odds ratios, 2.11-4.74). Similar results were noted for constant pain (but not intermittent pain) for PROMIS domains (effect sizes, 4.08-10.37) and clinically significant depression, anxiety, sleep disturbance and physical disability (odds ratios, 2.80-5.38).

Conclusions: Severe and constant pain are major drivers for poor psychological and physical health in CP. Systematic evaluation and management of psychiatric comorbidities and sleep disturbance should be incorporated into routine management of patients with CP. (ClinicalTrials.gov, Number: NCT03099850).

Keywords: Anxiety; Depression; PROMIS; Pancreas; Pancreatitis; Sleep disturbance.

MeSH terms

Chronic Pain* / epidemiology
Humans
Longitudinal Studies
Mental Health
Pancreatitis, Chronic* / complications
Pancreatitis, Chronic* / epidemiology
Patient Reported Outcome Measures
Quality of Life

Associated data

ClinicalTrials.gov/NCT03099850

Abstract

MeSH terms

Associated data

Grants and funding