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Intro:Surgical management of chronic pancreatitis is associated with poor outcomes due to intractable pain and concomitant physical and emotional dysfunction. Conventional thinking discounts the efficacy and safety of long-term opioid treatment in patients with chronic pain unassociated with a terminal disease. The purpose of this study is to report quality of life outcomes measured utilizing a computerized clinical tracking system in a chronic pancreatitis patient cohort treated with long-term opioid analgesia by a surgeon-directed multi-disciplinary team. Methods: A retrospective review and analysis of patients treated for failed surgical management of chronic pancreatitis from 1995 and 2009 was undertaken with IRB approval. Surgical failure was defined as persistent post-operative pancreatic pain requiring daily narcotic analgesia managed by a multidisciplinary surgeon-led team. Patient demographics, index operation, BMI, gastrointestinal symptoms, frequency of hospital readmission, daily morphine equivalent requirements, tube feed requirement, and TPN dependence. Quality of Life data was collected utilizing SF-36v2 implemented by the Element System, a computerized clinical tracking system.Results:34 patients were indexed in the study. 51 operations were performed and the average time from operation was 5.1 years (SD=2.94). 65% of the patients were female. The average age of the patients was 41 years old (SD=10). The BMI was 24.5 (SD=5.23). 29% underwent lateral pancreaticojejunostomy; 21% a distal pancreatectomy, 20% underwent a Whipple procedure and 14% underwent sphincteroplasty. The other operations were a Beger procedure (4%), revision of gastrojejunostomy (4%), pancreatic neck resection (2%), pancreatic necrosectomy (2%), choledochojejunostomy (2%) and Frey (2%). Patient symptoms following surgery were abdominal pain 100%, nausea/vomiting 91%, and anorexia 88%. 19 patients required hospitalization with a total of 55 admissions due to pain exacerbations. 9% of the patients required enteral tube feeds and 12% of patients were TPN dependent. The daily PO morphine equivalent was 414.12mg (SD=366.31). Quality of life scores are presented in Table 1.Conclusion: Opioid analgesic long-term therapy can likely be safely administered to patients with intractable pain associated with failed operative therapy of chronic pancreatitis. General health and physical vitality/energy scores were above standard norms. However, despite utilization of high dose narcotic analgesics, social functioning and patient physical and emotional role limits scores were low.
Table I: Quality of Life Scores

General Health	57.35	SD=3.93
Physical Functioning	33.19	SD=11.80
Social Functioning	36.05	SD=12.24
Mental Health	42.91	SD=5.66
Physical Quality of Life	39.42	SD=7.60
Psychological Quality of Life	42.74	SD=8.14
Role Limits (Physical)	33.54	SD=8.09
Role Limits (Emotional)	35.39	SD=14.77
Bodily pain	41.33	SD=9.76
Vitality/Energy	55.22	SD=8.68