Decompression procedures showed small effect on chronic pancreatitis pain

Extracorporeal shock-wave lithotripsy and endoscopic retrograde pancreatography reduced pain in patients with chronic pancreatitis more than a sham procedure at 12 weeks but not at 24 weeks.

Combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) provided some short-term pain relief to patients compared with sham procedures, a small trial found.

The trial, conducted a tertiary center in India, included 106 patients with chronic pancreatitis, 52 randomized to ESWL/ERP and 54 to sham procedures. The primary end point was pain relief on a 0- to 10-point visual analog scale (VAS) at 12 weeks. Results were published by Annals of Internal Medicine on May 28.

At 12 weeks, the ESWL/ERP group showed more pain relief (mean difference in change on the VAS, −0.7 [95% CI, −1.3 to 0]; P=0.039). However, the difference between groups was not sustained at the 24-week follow-up. At 12 weeks, the number of pain-free days was better in the intervention group (median difference, 16.2 days; 95% CI, 3.9 to 28.5 days), as was the number of days using opioids (median difference, −5.4 days; 95% CI, −9.9 to −0.9 days).

The clinical significance of the effect seen on pain is uncertain, "especially given the invasive nature of the ESWL/ERP procedure and the associated risks for complications and costs," said the study authors. They noted that there was an unexpected level of pain relief seen in the sham procedure group, possibly because the trial provided analgesics and optimized medical care.

Limitations of the study include that it was conducted at a single center and that pain diaries were used to determine the procedures' effects.