Pain relief after Frey's procedure for chronic pancreatitis

Abstract

Abstract Background Few studies have addressed long-term pain relief after Frey's procedure (local head resection with lateral pancreaticojejunostomy, LR-LPJ) for chronic pancreatitis. This retrospective study evaluated pain control using a validated score and risk factors associated with failure to achieve complete pain relief following LR-LPJ. Methods Sixty of 134 patients with chronic pancreatitis underwent LR-LPJ and were evaluated prospectively using the Izbicki pain score before surgery, and 1, 2, 5 and 7 years later. Analysis was on an intention-to-treat basis and predictors of complete pain relief were identified by multivariable analysis. Results After a median follow-up of 6·4 years, the median pain score was reduced from 46·4 to 10·0 (P < 0·001) with partial or complete pain relief in 75 per cent of patients, and a significant reduction in median number of episodes requiring hospitalization (from 4 to 0; P < 0·001). Preoperative use of opiate medication (odds ratio (OR) 30·14; P = 0·015), continuous pattern of pain (OR 22·65; P = 0·025) and occurrence of postoperative complications (OR 10·52; P = 0·030) were significant predictors of failure to achieve complete pain relief after surgery. Conclusion Frey's procedure leads to significant and sustained long-term pain relief in patients with chronic pancreatitis. Patients should be referred for surgery before opiates are needed to relieve pain.