SSAT - Preoperative Pain and Disability Score Predicts Long-Term Pain Relief After Total Pancreatectomy and Islet Cell Transplantation Compared to Assessment of Central Pain

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Preoperative Pain and Disability Score Predicts Long-Term Pain Relief After Total Pancreatectomy and Islet Cell Transplantation Compared to Assessment of Central Pain
Toms Augustin^*, Tyler Stevens, Bruce vrooman, Giries sweiss, Colin O'Rourke, R Matthew Walsh
Cleveland Clinic, Cleveland, OH

Purpose: While some papers have focused on quality of life outcomes after total pancreatectomy with Islet cell transplantation (TP-IAT) for chronic pancreatitis (CP), there is currently sparse research exploring the role of psychological factors and assessment of pain source by differential pain block and their relation to long term pain relief in these patients.

Methods: A retrospective review of prospectively collected data on patients undergoing TP-IAT from November 2007 through June 2015 was performed. Data regarding demographics, operative details, postoperative outcomes, psychological assessment as well as differential pain block was reviewed. Patients with purely central pain on pain block or adverse psychological assessment were not offered surgery.

Results: During the 7 year period, 60 patients underwent islet TP-IAT with a mean (±standard deviation, SD) follow-up of 29.5 ± 21.9 months. The average (±SD) patient age was 41.5 ± 4.9 years, and BMI was 26.2 ± 7.0. 47% of the patients were female. The etiology of the CP was most commonly idiopathic (n=29, 48.3%). Specific etiologies included genetic/familial (n=12, 20%), alcohol related CP (n=10, 16.7%), sphincter of Oddi dysfunction (n=3, 5%), pancreatic divisum (n=2, 3.3%) and hypertriglyceridemia (n=1, 1.7%). Daily narcotic use was noted in 81.7% of the patients with the average (± SD) morphine equivalents being 198.8 ± 467.4, and duration of pain 103.2 ± 93.6 months. Mean (± SD) depression, anxiety and pain disability index were 14.2 ± 11.7, 8.3 ± 7.8 and 41.9 ± 16.1, respectively. 22% of the patients qualified for a diagnosis of opioid disorder. Central pain block results were available for 30 patients; 29 of these patients were noted to have had pain relief with block and only 4 (13%) were noted to have a central pain component. Male gender, older age, and patients with higher pain disability score as well as higher pain score as noted in the numeric rating scale had better improvement in pain than patients without (all P values <0.05). Central pain component did not differentiate pain change after surgery in our series. At an average of 29.5 months follow-up, 25 (41.7%) patients were noted to be narcotic independent. Analysis for predictors of complete independence from narcotic use did not identify any significant predictor.

Conclusion: Patients with significant preoperative pain and disability, as well as high pain rating have the best improvement in pain after TP-IAT for CP. While in our series results of central pain block do not appear to predict either a change in pain or pain relief, we have tailored our use of TP-IAT for patients with limited central pain component with a normal psychological assessment, thus the importance of routine pain block and psychological evaluation in all patients considered candidates for surgery.

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