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Pancreatitis
STEPHEN H. THOMAS AND JONATHAN S. ILGEN
n Agents
n Opioids
n NSAIDs
n Cholecystokinin receptor agents
n Octreotide
n Glucagon
n Evidence
Opioids remain the most commonly used, and most commonly recommen-
ded, treatment for acute (and acute-on-chronic) pancreatitis. 1 Evidence
addressing opioids’ effect on the sphincter of Oddi and biliary tract pain
(see the chapter on biliary tract pain) may also be applicable in pancreatitis.
The data show little difference in efficacy between various opioids. Authors
criticizing the widespread practice of using meperidine (pethidine) for pan-
creatitis pain have noted that there is no contraindication to routine use of
morphine. 2,3
While most opioids are acceptable, there are reasons to select the mixed
agonist–antagonist buprenorphine. Buprenorphine appears to have advantages
related to a paucity of effect on Oddi’s sphincter. Perhaps related to this
property are reports of buprenorphine success when pure-agonist opioids
fail to control pancreatitis pain. 4,5 For instance, a trial has found that buprenorphine
achieves better analgesia than meperidine. 6 Use of an agent with
limited effects on the sphincter of Oddi can reduce confusion about the
etiology of the pancreatitis, by eliminating the opioid as a possible cause. 7
(In the rare instance in which mu receptor agonists cause pancreatitis,
naloxone is the indicated therapy.)
There may be situations in which oral agents may be appropriate for ED
therapy (e.g. chronic or less-severe pancreatitis). In these cases, PO tramadol
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