By the time patients suffering with chronic pancreatic pain see a psychiatrist for help, they’ve likely consulted many health care providers and tried various treatments — “often without much benefit,” says psychiatrist and pain specialist Traci Speed. “More than a few of these patients are likely to feel despondent.”
“Our goal is to change the status quo of pancreatic pain management: We aim to transform the experience by understanding how pain affects the whole person and individualizing treatment to improve function.” –Traci Speed
But there’s reason to feel hopeful about relief for their symptoms, she says. Speed, who works collaboratively in the Johns Hopkins Pancreatitis Pain Program with co-director Glenn Treisman, as well as with biobehavioral pain specialist Claudia Campbell, psychologist and sleep expert Molly Atwood and gastroenterologist Vikesh Singh. Speed describes the team’s approach: “We appreciate that everyone’s experience with pain is unique and deserves a comprehensive approach that targets both mental and physical health.”
The team includes nurse practitioners, psychiatrists, psychologists and pain specialists to address these patients’ needs. Together, the clinicians have created a two-hour consultation service to treat patients with atypical pain, as well as those with chronic abdominal pain.
Patients referred to the program have struggled with pain and often with psychiatric problems or addiction for years, and they may be experiencing sadness, worry, reduced quality of life and difficulty sleeping and performing daily activities, says Treisman. “Our goal is to individualize our approach for each patient to regain and maintain function, and effectively manage their pain by using medications that reduce pain and by teaching healthy behaviors.”
In their group at The Johns Hopkins Hospital, Treisman says they have seen more than 100 patients who have pain related to pancreatitis. “We’re using medications that target neuropathic pain, neurological symptoms and depression,” he says. “Opioids usually are not useful in chronic pain syndromes, and although they are very useful in acute pancreatitis, they are not sufficient to provide relief in patients with chronic pain — and can even make pain worse over time,” he notes. “We’ve found that medications that modulate the pain system and even sometimes electroconvulsive therapy can make a difference — calming nerves that are chronically damaged. A patient will come in, and we can identify who is likely to respond well to a certain drug.”
Gastrointestinal and psychiatric symptoms are often interconnected, says Treisman, which is why many of these patients were referred to the Johns Hopkins Center for Neurogastroenterology. Learning more about the brain-gut connection has led to a better understanding of why some people with gastrointestinal symptoms are more likely to experience high levels of anxiety and depression.
This collaborative and personalized approach has resulted in encouraging outcomes, says Treisman. “Many of these patients who have struggled with pancreatic pain for years are finally getting better. We’re seeing dramatic results, as we continue to offer hope to people who feel desperate because of symptoms that have persisted.”
Learn more about the Johns Hopkins Pancreatitis Pain Program.
Finally, Relief from Pancreatic Pain
The patient — a 36-year-old wife, mother and engineer — suffered with chronic abdominal pain for several years, caused by intermittent episodes of acute pancreatitis. She began to experience severe and recurring pain flares that would cause her to miss work and stay in bed for days at a time. Eventually, the pain became so constant and disabling that she had to leave her full-time job and spent most days in bed, not interacting with her family.
She had several long inpatient admissions to medical units for pain, with no relief. She developed avoidant/restrictive food intake disorder and was placed on intravenous total parenteral nutrition, also known as TPN. Her pain was managed with chronic opioid therapy. She sought consultations from several academic centers and was recommended to have a total pancreatectomy with islet cell transplantation. Hoping to avoid surgery, she looked for other options.
The patient was admitted to the Meyer 6 Pain Treatment Program. She consulted with Vikesh Singh, director of pancreatology, and other experts to clarify her diagnosis. The team treated her chronic pain, tapered her opioids and TPN, and helped her relearn how to eat. The care team treated her depression with neuromodulators that also targeted her abdominal pain, and she engaged in physical therapy and group therapy. By discharge, she was off TPN, eating full meals, was physically rehabilitated and had energy to engage with her children and husband.