Georg Dimcevski

The Characteristics of Pain in Chronic Pancreatitis: a Study Based on Experimental Pain Stimulations of the Gastrointestinal Tract Georg Dimcevski

The experiments forming the basis for the present thesis used different methods to induce and assess experimental pain stimuli in both healthy subjects and in patients with chronic pancreatitis. Furthermore in attempt to improve the pain models a multimodal and multi-tissue testing approach was successfully applied in these patients. Patients suffering from chronic pancreatitis are thought to have peripheral neural alterations and central changes in the pain system. One hypothesis is that the noxious activity in patients leads to peripheral, spinal and supraspinal changes in the pain system. We found generalized hypoalgesia to experimental visceral and somatic stimulations, but also evidence for central sensitization and cortical reorganisation. The findings suggest that activation and modulation of central mechanisms is fundamental in pancreatic pain. This may be related to changes in the balance between central hyperexcitability and pain modulating pathways. The findings of the present thesis may have clinical implications. Drugs which exert effects on the central nervous system or a combination of different drugs with targets in the central nervous system should be tested.