Pain intensity and prognosis of acute pancreatitis in an international, prospective study

Acute pancreatitis (AP) is a common inflammatory disease, with increasing incidence in many countries across the world1–3. The disease is characterized by abdominal pain, which is often described as severe and intense4. The clinical course may vary significantly, ranging from a mild disease that resolves spontaneously to more severe cases. Severe disease can include organ failure and pancreatic necrosis, resulting in significant morbidity and mortality5. As such, early identification of patients at risk of severe pancreatitis is crucial for optimizing management and improving outcomes.

Several systems have been used for the early prediction of AP severity, including the Glasgow-Imrie Criteria6, Ranson’s Criteria7, the Bedside Index of Severity in Acute Pancreatitis score8, and the Acute Physiology and Chronic Health Evaluation II score9. However, none of these includes pain assessment, despite pain being the presenting symptom. Higher pain intensity may reflect more widespread tissue damage, including pancreatic necrosis and local oedema. As such, specific features of pain, for example abdominal tenderness10, shorter duration of pain11,12, pain relapse during oral feeding13, and increased pain severity14, have been associated with severe AP. Given the variability in outcomes of AP, it remains uncertain whether pain intensity alone is sufficient for evaluating pain in AP and whether the assessment of pain intensity would increase the predictive accuracy for the clinical outcomes of AP.