Painful chronic pancreatitis

Eliminate ETOH
Low-fat diet
Normalize triglycerides
Avoid exacerbating drugs

Consider trial of endoscopic therapy

Opiate analgesic

Opiate analgesic

Pancreaticojejunostomy

Pancreatic resection

End

Persistent pain despite/requiring narcotic analgesics

Pain controlled

ETOH, Alcohol; EUS, endoscopic ultrasound; MRCP, magnetic resonance cholangiopancreatography.

MRCP/EUS

Pancreatic duct stricture or stones

Dilated pancreatic duct

Nondilated pancreatic duct

Simple analgesics, tramadol, gabapentin, pregabalin, low-dose antidepressants

Trial of oral pancreatic enzymes ± acid suppression for 1 mo

Pain controlled