Impaired diffuse noxious inhibitory controls: an additional mechanism of pain in chronic pancreatitis?

摘要

In general, treatment of underlying pain mechanisms yields the best results. The study by Olesen et al reported in this issue of Clinical Gastro enter ology and Hepatology suggests there may be more than a single mechanism present in chronic pancreatitis (CP) patients. There clearly is evidence of end-organ damage in CP, but how this damage is sensed may be different in these patients than in other tissue damage-related disorders. Olesen et al showed impaired endogenous pain control systems are present in subjects with CP by showing reduced diffuse noxious inhibitory controls (DNICs). In doing this, Olesen et al place CP in the company of painful disorders such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, temporomandibular disorder, atypical facial pain, chronic tension headaches, and other hypersensitivity disorders with limited identifiable pathology2"5 that have similar deficits in DNIC and separates CP from other disorders such as rheumatoid arthritis,6 which has DNIC mechanisms intact.