Chronic Pancreatitis

What is Chronic Pancreatitis?

Chronic pancreatitis is a progressive inflammatory disease in which repeated or continuing injury to the pancreas causes scarring (fibrosis) and permanent loss of function. The pancreas makes digestive enzymes and hormones such as insulin, so damage can affect both digestion and blood sugar.^{[1, 2]}

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

The most common symptom is pain in the upper abdomen, often described as recurring or constant, and about 80% of people with the disease have it.^[3] Other problems come from the loss of pancreatic function:

• Fatty, foul-smelling stools and weight loss when the pancreas no longer makes enough digestive enzymes^[1]
• Diabetes, which develops in roughly 4 in 10 people over time^[3]
• Poor nutrition and a higher risk of weak bones^[4]

Causes and risk factors

Heavy alcohol use and smoking are the best-known environmental causes, and genetic changes also play a role.^{[3, 5]} Repeated attacks of acute pancreatitis can lead to chronic disease, and in many people no clear cause is found.^{[2, 5]} Blockage of the pancreatic duct by stones or narrowing is another contributor.^[2]

How it is diagnosed and treated conventionally

Diagnosis rests on typical symptoms plus changes seen on imaging, such as calcifications, duct stones or strictures, and sometimes endoscopic ultrasound and pancreatic function tests.^{[2, 3]}

Treatment is multidisciplinary. First-line care is stopping alcohol and smoking and using pain medicines. Many people also need pancreatic enzyme replacement, nutrition support and diabetes treatment, and some need endoscopic or surgical drainage when a duct is blocked.^{[3, 6]} In a meta-analysis of 17 studies, enzyme replacement improved fat absorption in people with insufficient enzyme production.^[7]

Why Chronic Pancreatitis calls for a whole-person approach

Chronic pancreatitis affects more than one body system. Pain, digestion, nutrition, blood sugar, bone health and mood all interact, which is why guidelines call for a team approach that includes psychological care.^[2]

Supportive care, where used, is aimed at comfort, eating and stress alongside treatment of the pancreas itself.

Pain and its effect on eating

Long-lasting abdominal pain can reduce how much a person eats, which adds to the risk of malnutrition.^[4] Easing pain may therefore help nutrition as well as comfort.

Digestion and nutrition

Poor fat digestion and nutrient loss are common, so people with chronic pancreatitis are considered at risk of malnutrition and are screened for it.^{[4, 8]} A balanced diet is the cornerstone recommendation, and specific deficiencies are treated as they are found.^[8]

Oxidative stress and inflammation

Researchers believe that oxidative stress, an imbalance involving damaging reactive molecules, contributes to pancreatic injury and its complications.^[9] Trials of antioxidant supplements have given mixed results, described under herbal medicine below.

Bone health

People with chronic pancreatitis are at increased risk of osteoporosis and fractures, and preventive measures should be considered.^[4] This is one reason regular medical follow-up matters.

Acupuncture as supportive care in Chronic Pancreatitis

What the research shows

Evidence for acupuncture in chronic pancreatitis is limited to two small trials, and it does not show a lasting benefit. In a 2017 crossover trial of 15 patients, one acupuncture session gave more pain relief than sham stimulation. The effect was short, and after one week there was no difference between the groups.^[10]

An older 1985 randomized study of 23 patients with chronic pancreatitis tested electroacupuncture and a nerve-stimulation device against sham. It concluded that neither gave pain relief that could replace or add to medical treatment.^[11] A 2023 review of non-drug pain approaches lists acupuncture among the options but stresses the need for personalized, multidisciplinary pain management.^[12]

For chronic pain in general, a meta-analysis of data from 20,827 patients in 39 trials found acupuncture better than no acupuncture and better than sham for musculoskeletal pain, osteoarthritis, headache and shoulder pain. These conditions are not pancreatic pain, so the result does not show it would work in chronic pancreatitis.^[13]

How acupuncture may work

The proposed mechanism in pancreatic pain is a change in how the brain and nervous system process pain signals. In the 2017 trial, researchers recorded brain activity to look for this, but found no measurable difference between real and sham acupuncture.^[10] The mechanism in this condition is therefore unproven.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course is several visits, and we reassess to see whether it is helping with symptoms such as pain, nausea or stress.

Serious problems are rare. In prospective studies about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell your practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Needling over the abdomen is a matter to discuss with your physician if you have had pancreatic surgery or have a pseudocyst.

Ayurvedic medicine as supportive care in Chronic Pancreatitis

The Ayurvedic view

Ayurveda does not have a single traditional name that matches chronic pancreatitis. Practitioners may describe a person's digestive weakness and pain through frameworks such as agni (digestive fire) and Pitta or Vata imbalance. These are traditional concepts for choosing supportive care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular, simple meals and steady daily routines, which must fit the nutrition advice from your dietitian and physician, since people with this disease are screened for malnutrition^[4]
• Gentle warm oil massage and stress-reducing practices
• Individually prescribed herbs for digestion, comfort or stress, from tested sources, because about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic^[15]

Panchakarma, the traditional cleansing program, is not appropriate during acute illness, in frailty, in pregnancy, or with malnutrition, and it is not suitable for active pancreatic disease.

What the research shows

We found no clinical trials of Ayurvedic medicine, including Panchakarma, in chronic pancreatitis. A PubMed search turned up no systematic reviews or controlled studies. Any Ayurvedic care here is therefore supportive and aimed at comfort, sleep and stress, not at the pancreatic disease.

Herbal medicine as supportive care in Chronic Pancreatitis

Herbs and formulas that have been studied

We found no clinical trial of an herbal formula in chronic pancreatitis. The Chinese herbal trials we found were in acute pancreatitis, a different hospital-treated illness. The best-studied supplements in chronic pancreatitis are antioxidant vitamin and mineral combinations, which are not herbs.

What the research shows

There is no herbal evidence for chronic pancreatitis itself, so any herbal care is supportive and aimed at symptoms such as digestion or stress.

Antioxidant supplements are the nearest comparison and the results conflict. A meta-analysis of 8 trials with 573 patients found more pain relief with antioxidants, along with more adverse reactions.^[16] A double-blind trial of 70 patients found no difference from placebo in pain or quality of life,^[17] and a later meta-analysis of 4 trials found no significant pain benefit.^[18] A review of nutrition trials found no effect of antioxidants on pain.^[8]

Safety and herb-drug interactions

Herbs can interact with medicines and should be reviewed with your physician. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[19]

Herbal and dietary supplements are also a recognized cause of liver injury, and the ingredient responsible is often hard to identify.^[20] In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[15] People with chronic pancreatitis often take several medicines, including pain medicines, enzymes and insulin, so every herb or supplement should be disclosed. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

These links are interpretation, not equivalence. Chinese medicine may describe chronic upper abdominal pain as stagnation of qi and blood, and weak digestion as a spleen deficiency pattern. Researchers study ideas that loosely parallel these, such as pain signaling in the nervous system and the effects of long-term inflammation and poor nutrition.^{[9, 10]}

In Ayurveda, weak agni describes poor digestion. The biomedical counterpart in this disease is the loss of digestive enzymes, which is treated with enzyme replacement.^[7] No study has shown that a dosha or pattern corresponds to a specific biological process in the pancreas.

How this care fits with your medical care

Supportive care here is complementary. We do not diagnose or manage pancreatic disease, and we do not prescribe or change medicines. Keep your gastroenterologist, pain specialist and dietitian, and do not stop or change prescribed enzymes, insulin or pain medicines without your prescriber.

Please bring your diagnosis, recent imaging and test results, a full list of medicines and supplements, and your dietary advice. If you drink alcohol or smoke, your medical team can help you stop, since stopping is the first line of treatment.^[3]

When to seek urgent medical care

Some symptoms may signal an acute attack, an obstruction or another serious complication of pancreatic disease.^[2]

• Sudden severe abdominal pain, especially with vomiting
• Fever or chills with abdominal pain
• Yellowing of the skin or eyes
• Vomiting that does not stop, or inability to keep fluids down
• Black or bloody stools, or vomiting blood
• Very high thirst and urination, confusion or extreme drowsiness, which can signal dangerously high blood sugar
• Unplanned weight loss that keeps getting worse

If any of these occur, call 911 or go to the nearest emergency department.