CHRONIC PANCREATITIS TESTING AND DIAGNOSIS

Chronic pancreatitis is best diagnosed with tests that can evaluate the structure of the pancreas via radiography (x-ray exams)—blood tests are generally not helpful for making the diagnosis of chronic pancreatitis. As with acute pancreatitis, a doctor will conduct a thorough medical history and physical examination. Physicians have a variety of diagnostic tests to choose from:

• Transabdominal Ultrasound

Sound waves are sent toward the pancreas via a handheld device that a technician glides over the abdomen. The sound waves bounce off the pancreas, gallbladder, liver, and other organs, and their echoes generate electrical impulses that create an image—called a sonogram—on a video monitor. If gallstones are causing inflammation, the sound waves will also bounce off of them, showing their location.

• Endoscopic Ultrasound

After spraying a solution to numb the patient’s throat, the doctor inserts an endoscope—a thin, flexible, lighted tube—down the throat, through the stomach, and into the small intestine. They then turn on an ultrasound attachment to the endoscope, which produces sound waves to create visual images of the pancreas and bile ducts. 

• Magnetic Resonance Cholangiopancreatography (MRCP)

MRCP uses magnetic resonance imaging (MRI), a noninvasive procedure that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube. The technician injects dye into the patient’s veins, which helps show the pancreas, gallbladder, and pancreatic and bile ducts.



• Computerized Tomography (CT)

A CT scan is a noninvasive radiograph (x-ray) that produces 3-dimensional images of parts of the body. The patient lies on a table that slides into a donut-shaped machine. The test can show gallstones and the extent of damage to the pancreas.

Occasionally, blood tests, such as a test for IgG4 to assess for autoimmune pancreatitis, can be used to help diagnose the cause of chronic pancreatitis. However, blood tests are not typically used to make the diagnosis of chronic pancreatitis.

CHRONIC PANCREATITIS PAIN MANAGEMENT AND TREATMENT

Pain Management

Significant pain associated with chronic pancreatitis can seriously reduce a patient’s quality of life. It is important to treat chronic pancreatitis as soon as it is diagnosed because repeated episodes of inflammation can cause irreversible damage, and pain relief becomes much less effective. Pain relief can be achieved with medication, often using the World Health Organization’s 3-step ladder approach to pain relief:

1. Pain medication begins with nonopioids (like acetaminophen, ibuprofen, or both).
2. If nonopioids do not relieve pain, mild opioids (like codeine) are given.
3. If mild opioids do not relieve pain, strong opioids (like morphine) are given.

Many patients with chronic pancreatitis receive antioxidants with their pain medicine, which has been shown to help with pain relief.3-5 There are other options for pain relief, such as a celiac plexus block, which may provide another option for significant pain relief. The celiac plexus block is achieved via injection and prevents the nerves that travel from the pancreas from reporting pain signals back to the brain.

If there is a narrowing of the pancreatic duct, placement of a plastic tube called a stent into the duct can be helpful in alleviating pain symptoms.

Limited Role of Endoscopic Retrograde Cholangiopancreatography (ERCP)

An ERCP test, in which a flexible endoscope is placed into the intestine and a catheter is used to inject dye into the pancreas, should generally not be used in chronic pancreatitis, and it should never be used to diagnose chronic pancreatitis because injecting dye into the pancreas can cause pancreatitis. 

Surgery

When medical therapy fails to provide relief to patients with chronic pancreatitis, surgical therapy may be an option. A lateral pancreaticojejunostomy (modified Puestow procedure) can result in pain relief in up to 80% of patients.

Whipple Procedure

Another surgical procedure, which can remove inflammation and masses on the head of the pancreas, is the classic Whipple procedure; however, this procedure does remove a lot of important tissue and can be associated with complications such as increased risk of death. When possible, modified Whipple procedures are performed to save more tissue compared to the classic Whipple procedure, and can be successful for pain relief and return to daily activity. 

TPIAT

For appropriately selected patients whose pain remains incapacitating despite standard medical and surgical approaches, total pancreatectomy with islet auto-transplantation (TP-IAT) – while not a panacea – yields significant relief of symptoms. 

Antioxidant Therapies

Basic and clinical evidence suggests that the development of both acute pancreatitis (AP) and chronic pancreatitis (CP) can be associated with oxidative stress. Findings show that free radical activity and oxidative stress indices are higher in the blood and duodenal juice of patients with pancreatitis.

Based on these findings, the idea of using antioxidant regimens in the management of both AP and CP as a supplement and complementary in combination with its traditional therapy is reasonable. In practice, however, the overall effectiveness of antioxidants is not known, and the best mixture of agents and dosages is not clear. Currently, a trial of a mixture of antioxidants containing vitamin C, vitamin E, selenium, and methionine is reasonable as one component of overall medical management.

In summation, there is no definite consensus on the dosage, length of therapy, and ultimately, the benefits of antioxidant therapy in the management of AP or CP. Further well-designed clinical studies are needed to determine the appropriate combination of agents, time of initiation, and duration of therapy.

Bilateral Thoracoscopic Splanchnicectomy

This is an option for intractable, chronic pain but it is not widely available.  Is is a surgical resection of one or more of the splanchnic nerves for the treatment of intractable pain. It is usually performed by a thoracic surgeon when it is done.

Medicines Two Choices for You

Dr. Huntoon has a completely different perspective based on understandings given to him by one of his mentors, Dr. Victor Frank. 

Over the past 27 years while applying the understandings of Dr. Frank and the teachings of Traditional Chinese Medicine (TCM), Dr. Huntoon has learned to address Pancreatitis by directly addressing the underlying CAUSE(S). This is based on a case by case basis since there are so many factors to consider and each person is treated for their unique, individual circumstances. He has also helped people eliminate the excess inflammation associated with Pancreatitis by using Whole Food Supplements and Homeopathic Remedies.

OTHER COMPLEMENTARY PANCREATITIS THERAPIES

Alternative therapies are those that can be used along with medical treatment to help the patient feel better. No one should begin an alternative therapy without speaking with his or her physician.

Yoga

Research has found that patients with chronic pancreatitis who practice yoga 3 times per week can reduce pain, reduce the need for pain medication, and improve quality of life.1,2

Massage Therapy

Massage therapy involves touch and different techniques of stroking or kneading the muscles of the body. It can involve part of the body or be a full-body massage. Massage can be performed through one’s clothing or on the exposed skin. It can be performed in specialized chairs or on a table. Massage therapy should only be performed by a licensed massage therapist.

Massage is used for muscle and bone discomfort; improvement of circulation; reduction of swelling; relaxation; and pain control. It can be used as a complement to other treatments and as a stress reducer. Studies have shown that massage can improve the relaxation response and the general sense of well-being.

Therapeutic Touch

Therapeutic touch is a process of energy exchange, in which the practitioner uses the hands as a focus to help the healing process. It is based on the idea that humans are a form of energy. When we are healthy, the energy is flowing freely and is balanced. Disease is believed to reflect an imbalance or disturbance of the energy flow.

Therapeutic touch treatment can vary from 5 to 30 minutes, depending on the needs of the individual patient. Exact methods vary among practitioners, but generally they will hold their hands 2 to 4 inches away from the patient’s fully clothed body, moving them from head to toe, and over the front and back. Research has demonstrated that therapeutic touch promotes relaxation and a sense of comfort and well-being. Research has also shown therapeutic touch to be effective in decreasing anxiety and altering the perception of pain.

Physical Exercise

Physical exercise improves the overall functioning of the body and quality of life. Exercise can decrease stress, pain, nausea, fatigue, and depression. Regular exercise affects hormonal balance as well as most of the body systems. Regular participation in physical activity increases the heart rate and maintains an increased heart rate for a period of time.

Depending on your physical condition, and after the advice of your physician, you can begin walking 5 to 10 minutes twice a day, with a goal of increasing activity to 45 minutes at least 3 times a week. It is important that your exercise time be without interruptions. This is time for yourself. If you are unable to walk, there are other ways to exercise (eg, stretching, isometric exercises).

Meditation

Meditation or relaxation encourages a state of freedom from anxiety, tension, and distress. A state of relaxation can be achieved using different methods, such as diaphragmatic breathing, progressive muscle relaxation, repetitive affirmation, prayer, yoga, or guided/visual imagery. When practiced regularly, meditation can improve sleep, concentration, and the ability to cope with stress. It can help with the management of pain, nausea, and anxiety. You can find free tapes and booklets about meditation at libraries and low-cost materials in stores. You can also choose to attend groups or work groups. Once you have learned the technique, meditation can be practiced at no cost.

Laughter

Science is taking a closer look at the effects of “mirthful” laughter, that is, laughter that is provoked by happiness, not laughter that is the result of emotions such as embarrassment and anxiety. Whereas it is easy to see how laughter can boost one’s mood, many researchers are finding evidence that mirthful laughter can indeed boost one’s immune system. More research is necessary to elucidate the positive aspects of laughter.

Acupuncture

The term acupuncture describes a set of procedures involving stimulation of anatomic points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

1. Besselink MG, van Santvoort HC, Buskens E, et al; Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 2008;371(9613):651–659.
2. van Santvoort HC, Besselink MG, Bakker OJ, et al; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362(16):1491–1502.
   

Dr. Huntoon has a completely different perspective based on understandings given to him by one of his mentors, Dr. Victor Frank. 

Over the past 28 years while applying the understandings of Dr. Frank and the teachings of Traditional Chinese Medicine (TCM), Dr. Huntoon has learned to address Pancreatitis by directly addressing the underlying CAUSE(S).  This is based on a case by case basis since there are so many factors to consider and each person is treated for their unique, individual circumstances. He has also helped people eliminate the excess inflammation associated with Pancreatitis by using Whole Food Supplements and Homeopathic Remedies.

Working with a Holistic Chiropractor who has experience in addressing the underlying CAUSAL COMPONENTS associated with your Acute Pancreatitis is warranted.

Others have benefited from Acupuncture, Homeopathy and Naturopathy.