What are the symptoms of acute pancreatitis?
Abdominal pain is very common and frequently unbearable in patients with acute pancreatitis. In a lot of cases, patients may initially present with episodes of pain, combined with periods of feeling relatively well. Stigliano et al. suggest that all patients with acute pancreatitis or suspected pancreatitis must receive some form of analgesia within the first 24 hours of hospitalization in order to not compromise the patient’s quality of life. Although pain is usually secondary to multifactorial pathogenetic mechanisms, it has been considered that the action of pancreatic enzymes and inflammatory mediators can stimulate visceral pancreatic or somatic peritoneal pain receptors. When analgesia is administered at first, it is frequently unsuccessful, and many patients require a stronger prescription, usually an opioid. In recent decades, morphine, the ‘gold standard’ for general pain relief, has been excluded from acute pancreatitis treatment based on indirect findings on the spastic action on the sphincter of Oddi.
However, on the other hand, pethidine is now the opioid of choice because of its low spasmodic activity on the sphincter of Oddi, and it is usually recommended for pain in acute pancreatitis. Although Pethidine can induce epileptic seizures in patients with renal impairment, which is a potential complication in acute pancreatitis. For these reasons, the selection of an analgesic is controversial these days, and each individual patient needs to be assessed.