How should I approach the management of pain in a patient with chronic pancreatitis?

Manage pain in chronic pancreatitis by initially offering paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) for mild-to-moderate pain, considering contraindications and adverse effects ¹.

For severe pain, consider adding a weak opioid such as codeine phosphate, with caution regarding dependency and adverse effects ¹.

Consider the addition of drugs such as amitriptyline or gabapentin for neuropathic pain, depending on clinical judgement ¹.

Be aware that pain mechanisms are multifactorial, involving duct obstruction, nerve damage, inflammation, and central sensitization, which may influence treatment choices ¹.

Use neuropathic pain drugs as indicated, especially if no clear cause for pain is identified, to reduce reliance on opioids ¹.