Muraviov P. T., Shevchenko V. G., Gomoniuk I. V., Kravets K. V., Kharkhuri Makrem

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The origin of pain in jaundiced patients with the cancer of the pancreatobiliary zone and chronic pancreatitis hasn’t been entirely studied yet. The aim of the study was to assess the effect of cholemia on the severity of pain syndrome in patients with surgical pathology of the pancreas. The results of surgical treatment of 54 patients with chronic pancreatitis and 218 patients with pancreatobiliary cancer complicated by obstructive jaundice were analyzed. In these patients pancreatoduodenal resection was performed. The main group patients (112 patients) have been prepared to surgery by combination of conservative measures for express detoxification and decompression of the biliary tract. The control one (160 patients) – only conservatively. The severity of pain syndrome was assessed using a visual analogue scale. In main group, the initial level of total bilirubin was 274.3±5.9 μmol/L, direct – 211.2±2.2 μmol/L, indirect – 63.4±2.6 μmol/L. In the control group – 270.6±4.6 mmol/L, 206.3±2.4 mmol/L and 64.1±2.6 mmol/L. The intensity of pain syndrome on admission was 4.9±0.4 and 5.7±0.2 points in the main and control groups, respectively. Due to the preoperative preparation, there was a slight decrease in the intensity of pain according to the visual analogue scale (4.5±0.4 points in the main and 5.4±0.3 points in the control group). In the main group, the intensity of pain decreased, respectively, from 6.4±0.3 through 5.1±0.4 to 2.8±0.4 points. In the control group – from 8.6±0.4 through 6.7±0.5 to 3.1±0.2 points. A strong positive correlation between the intensity of pain syndrome and the level of cholemia was determined (r = 0.74 in the main and r = 0.79 in the control groups).

cholemia, pain syndrome, pancreas, chronic pancreatitis, pancreatic cancer, pancreatoduodenal resection

1. Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of Chronic Pain: Domains, Methods, and Mechanisms. J. Pain. 2016;17(9):T10-T20. DOI: 10.1016/j.jpain.2015.08.010
2. Koulouris AI, Banim P, Hart AR. Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments. Dig. Dis. Sci. 2017;62(4):861-70. DOI: 10.1007/s10620-017-4488-z
3. Kuhlmann L, Olesen SS, Olesen AE, Arendt-Nielsen Lars, Drewes AM. Mechanism-based pain management in chronic pancreatitis – is it time for a paradigm shift? Expert Rev. Clin. Pharmacol. 2019;12(3):249-58. DOI: 10.1080/17512433.2019.1571409
4. Lohse I, Brothers SP. Pathogenesis and Treatment of Pancreatic Cancer Related Pain. Anticancer Res. 2020;40(4):1789-96. DOI: 10.21873/anticanres.14133
5. So M, Bansal N, Piracha MM. Neuromodulation and Pancreatic Cancer Pain. J. Palliat. Med. 2018;21(8):1064-6. DOI: 10.1089/ jpm.2018.0109
6. Wild CP, Weiderpass E, Stewart BW. World cancer report: cancer research for cancer prevention. Lyon: 2020. 600 p. Available from: https://www.iccp-portal.org/sites/default/files/resources/IARC%20World%20Cancer%20Report%202020.pdf
7. Fedorenko ZP. Bulletin of National cancer registry of Ukraine. Kyiv: 2020. Available from: http://www.ncru.inf.ua/publications/BULL_21/ PDF_E/30-31-podg.pdf
8. Dumitra S, Jamal MH, Aboukhalil J, Doi SA, Chaudhury P, Hassanain M, et al. Pancreatic cancer and predictors of survival: comparing the CA 19-9/bilirubin ratio with the McGill Brisbane Symptom Score. HPB (Oxford). 2013;15(12):1002-9. DOI: 10.1111/hpb.12085
9. Arora A, Rajesh S, Mukund A, Patidar Y, Thapar S, Arora A, et al. Clinicoradiological appraisal of ‘paraduodenal pancreatitis’: Pancreatitis outside the pancreas! Indian J. Radiol. Imaging. 2015;25(3):303-14. DOI: 10.4103/0971-3026.161467
10. Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic Pancreatitis. The Lancet. 2020;396(10249):499-512. DOI: 10.1016/S0140- 6736(20)31318-0
11. Patel V, Willingham F. The Management of Chronic Pancreatitis. Med. Clin. North. Am. 2019;103(1):153-62. DOI: 10.1016/j. mcna.2018.08.012
12. Singh VK, Yadav D, Garg PK. Diagnosis and Management of Chronic Pancreatitis: a review. JAMA. 2019;322(24):2422-34. DOI: 10.1001/ jama.2019.19411
13. Téllez-Ávila FI, Villalobos-Garita А, Giovannini M, Chan C, Hernández-Calleros J, Uscanga L, et al. Follow-up of patients with pseudotumoral chronic pancreatitis: outcome and surveillance. World J. Gastroenterol. 2014;20(26):8612-6. DOI: 10.3748/wjg.v20.i26.8612
14. Nichitaylo ME, Snopok YuV, Bulik II. Kisty i kistoznyye opukholi podzheludochnoy zhelezy. Kiyev: CHAO «Poligrafkniga»; 2012. 544 s. [in Russian].
15. Zhu J, Miao XR, Tao KM, Zhu H, Liu ZhY, Yu DW, et al. Trypsin-protease activated receptor-2 signaling contributes to pancreatic cancer pain. Oncotarget. 2017;8(37):61810-23. DOI: 10.18632/oncotarget.18696

«Bulletin of problems biology and medicine» Issue 4 (158), 2020 year, 167-172 pages, index UDK 616.37-089:616.154.36

10.29254/2077-4214-2020-4-158-167-172