Some have advocated supportive therapy for abdominal pain on the premise that fibrosis and scarring ultimately progress to pancreatic burnout and spontaneous relief of pain. Although long-term improvement in pain has been observed in some patients with CP, a significant subset of patients experiences debilitating pain for decades. The AGA technical review has stated that "a strategy of waiting for spontaneous pain relief is not reliable and may be unreasonable advice for the patient with persistent, severe pain." Furthermore, there is growing evidence that there is no association between duration of CP and improvement in pain. Medical options for pain relief include abstinence from alcohol and smoking, analgesics, and pancreatic enzymes. Abstinence from alcohol is critical because continued use can hasten disease progression, aggravate chronic pain, and increase mortality. Non-narcotic analgesics (., nonsteroidal anti-inflammatory drugs, acetaminophen, and tramadol) are the next step in managing painful CP. The role of smoking in the progression of fibrosis and functional impairment has been established in recent studies. Therefore smoking cessation should also be strongly advised. If pain persists, low doses of mild narcotics may be added. Severe or recalcitrant pain can warrant the use of stronger opiates in selected cases.
IgG4-related sclerosing disease , also known as IgG4–related systemic disease (IgG4-RSD), hyper-IgG4 disease and IgG4-related disease is an autoimmune disease in which inflammatory cells cause fibrosis, the deposition of connective tissue, in one or more organs. The disease is so named because the antibody subtype IgG4 can be detected on tissue samples and often at elevated levels in the bloodstream. The association with IgG4 is a relatively recent finding, and the condition has been described under numerous other names in the past.
Based on histological and immunohistochemical examination of various organs of patients with autoimmune pancreatitis (AIP), a novel clinicopathological entity of IgG4-related sclerosing disease has been proposed. This is a systemic disease that is characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. Clinical manifestations are apparent in the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate, in which tissue fibrosis with obliterative phlebitis is pathologically induced. AIP is not simply pancreatitis but, in fact, is a pancreatic disease indicative of IgG4-related sclerosing diseases. This disease includes AIP, sclerosing cholangitis, cholecystitis, sialadenitis, retroperitoneal fibrosis, tubulointerstitial nephritis, interstitial pneumonia, prostatitis, inflammatory pseudotumor and lymphadenopathy, all IgG4-related. Most IgG4-related sclerosing diseases have been found to be associated with AIP, but also those without pancreatic involvement have been reported. In some cases, only one or two organs are clinically involved, while in others, three or four organs are affected. The disease occurs predominantly in older men and responds well to steroid therapy. Serum IgG4 levels and immunostaining with anti-IgG4 antibody are useful in making the diagnosis. Since malignant tumors are frequently suspected on initial presentation, IgG4-related sclerosing disease should be considered in the differential diagnosis to avoid unnecessary surgery.