Does Pancreatitis Pain Come and Go?
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Pancreatitis pain is unique.
The pain often starts abruptly in acute pancreatitis and becomes severe and persistent for several days.
Acute pancreatitis pain is unlikely to come and go in episodes; however, patients may experience exacerbations and partial remissions.
On the other hand, patients with chronic pancreatitis may experience recurrent abdominal pain that comes and goes in attacks for several years.
Keep reading this article to understand the characteristic of pancreatitis pain in both acute and chronic pancreatitis.
1. Does acute pancreatitis pain come and go?
In most cases of acute pancreatitis, the pain is often persistent and severe. Acute pancreatitis pain may be partially relieved by sitting up or leaning forward. But it doesn’t go away completely.
Moreover, The character and severity of pain may differ according to the cause of pancreatitis.
For example, people with acute pancreatitis due to alcohol abuse often have less abrupt and poorly recognized pain.
On the other hand, patients with acute pancreatitis due to gallstones often have a more rapid onset and sharper pain. In addition, patients with gallstone pancreatitis may experience exacerbation and partial relief (the pain doesn’t go away completely).
Features of acute pancreatitis pain (reference):
- Onset: The onset of pain is often abrupt. The pain evolves rapidly.
- Course: The pain often persists for several days and doesn’t disappear. You may experience.
- Site: the pain is in the upper central abdomen (epigastric area) and the left upper abdomen area. Some patients may also feel pain in the right upper quadrant. Rarely the pain may be confined to the left upper quadrant.
- Radiation of the pain: In 50% of the patients, the pain often radiates to the center of the mid-back.
- What relieves the pain: the pain often is partially relieved by sitting up or bending forward.
- Associated symptoms: nausea and vomiting are present in 90% of the patients.
Acute pancreatitis pain is often persistent. It is not usual for pancreatitis pain to come and go away completely.
2. Causes of pain that comes and goes & mimic pancreatitis.
Several painful conditions may cause upper abdominal pain that mimics pancreatitis pain.
- Biliary colics.
- An attack of acute gastritis.
- Irritable bowel syndrome.
- Functional dyspepsia.
- Chronic pancreatitis (discussed in the next section).
Biliary colic (gallbladder attacks) has bouts of severe pain (similar to pancreatitis pain severity) that come and goes. However, the pain is often in the right upper abdomen (the gallbladder area).
But sometimes, biliary colic pain may become central (epigastric), resembling pancreatitis. So, the most important cause of pain that comes and goes resembling pancreatitis pain, is gallbladder pain.
The table below illustrates the characteristics of a gallbladder attack:
You can learn more in this article: Mimics of gallbladder pain.
Surprisingly, about 5-10% of patients with acute pancreatitis may not have pain!
3. Does chronic pancreatitis pain come and go?
The pattern of pain with chronic pancreatitis is different among patients. Some patients may experience chronic relentless pain that doesn’t go away. In others, the pancreatitis pain may come and go in attacks.
The severity of pain varies according to the cause, and it may change over time. However, pain severity doesn’t correlate with the severity of damage to the pancreas in chronic pancreatitis.
Three recognized patterns of pain can occur with acute pancreatitis:
- Persistent pain (for months or years, doesn’t go away).
- Exacerbations and partial remissions.
- Attacks of pain then pain-free periods (AKA, the pain comes and goes).
Symptoms suggesting chronic pancreatitis:
1 . Abdominal pain
- The pain can be any one of the three patterns mentioned above.
- It is often less severe than acute pancreatitis pain.
- It may come and go in the upper central abdomen (epigastric area) and radiate to the back.
- The pain may exacerbate when you lay on your back or after meals.
2. Steatorrhea (fatty diarrhea).
- Ongoing pancreatic damage often results in malabsorption of foods, especially fats, due to lipase enzyme deficiency.
- Patients experience persistent or recurrent greasy (oily) offensive diarrhea or loose stool attacks.
- The stool color is often yellowish or greasy and may float in the toilet.
- Steatorrhea often develops LATE after 5-10 years of chronic pancreatitis (reference).
- So, its absence doesn’t exclude pancreatitis when you have pain that comes and goes resembling pancreatitis.
3. Asymptomatic or mild pain that comes and goes.
- A small percentage of patients with chronic pancreatitis may be completely asymptomatic or have minimal symptoms.
- Some patients also may have minimal intermittent symptoms such as abdominal pain that comes and goes.
- If your pain is not responding to simple anti-acid and antispasmodic medications, discuss with your doctor the possibility of chronic pancreatitis (especially if you have risk factors).
- Risk factors for chronic pancreatitis include:
– Alcoholism (responsible for 50% of the cases of chronic pancreatitis in the USA).
– Increased blood lipids (triglycerides).
– Diabetes mellitus.
– Recurrent acute pancreatitis.
4. Other symptoms:
- Recurrent vomiting.
- Shortness of breath.
- Weight loss.
- Excessive thirst.
- Generalized weakness and fatigue.
5. Causes of chronic abdominal pain that comes and goes (mimics chronic pancreatitis).
- Chronic gastritis and peptic ulcer disease (PUD).
Chronic inflammation or ulceration of the stomach and duodenum causes attacks of upper central (epigastric) pain that comes and goes for long periods. The pain often is exaggerated by meals and is relieved by antacids and proton pump inhibitors like omeprazole.
- Irritable bowel syndrome (IBS).
Irritable bowel syndrome is a very common functional disease that often presents with recurrent abdominal pain and changes in bowel habits, and the pain often decreases by defecation.
- Functional dyspepsia (FD).
Functional dyspepsia is another functional disease that causes discomfort or pain in the epigastric area after meals. The condition is chronic, and the pain or discomfort often comes and goes over long periods.
- GERD (Acid reflux).
Gastroesophageal reflux disease (GERD) or acid reflux is a chronic condition when significant amounts of stomach acid reach the esophagus.
The condition often presents burning chest pain and regurgitation of food or acidic material into the throat. However, some patients with GERD may complain of upper abdominal pain that comes and goes (especially if they have a hiatal hernia).
- Food intolerance.
Food intolerance occurs when your body cannot digest certain types of food or food constituents. Common examples include lactose intolerance and FODMAP intolerance.
Food intolerance patients may have Recurrent episodes of abdominal pain, chronic diarrhea, and excess gases.
- Celiac disease.
- Gallstone disease.
- Other pancreatic diseases such as cancer pancreas.
6. When to see a doctor.
Your doctor should evaluate any significant abdominal pain that comes and goes without apparent cause. However, The pain is more likely to be something serious when it is associated with:
- Chronic diarrhea (especially if it is offensive or greasy).
- Weight loss.
- Severe nausea or vomiting.
- Jaundice (yellow skin and eye whites).
- Persistent loss of appetite (anorexia).
- Significant abdominal pain that doesn’t respond to antispasmodic and other stomach medicines.
- Severe or persistent abdominal distension (excess gases).
- Blood in the stool or black tarry stools.