Various pancreatic causes, including increased intra-ductal pressure, ischaemia, neural alterations, etc., and extrapancreatic causes, including duodenal/common bile duct stenosis, etc., have been suggested to be responsible for the pain in CP. The existence of multiple hypotheses to explain the patho-physiology of pain in CP is reflected in the diverse management options that are adopted in the treatment of pain in various presentations of CP.

Diagnosis
It is widely accepted that routine blood tests are usually not helpful for the diagnosis of CP – the diagnosis is more clinical and based on patient symptoms. Pain usually begins in the upper abdomen with radiation to the back, and patients presenting with a history of similar such episodes may require hospitalisation and management of pain with analgesics. Some patients also have a history of previous attacks of acute pancreatitis. While alcohol is responsible for alcoholic CP, there are hereditary, tropical and other variants as well. A number of patients suffer from diabetes mellitus and some may report steatorrhoea.

CP is mainly confirmed by a combination of careful patient history and radiologic imaging – i.e. computed tomography (CT) and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP). Not only do these imaging modalities help in disease documentation and localisation, but they are invaluable for management plans.

Management of CP
The different treatment modalities for management of CP are medical measures, therapeutic endoscopy and surgery. Patients should be evaluated with appropriate laboratory tests and through CT scans or MRCP and rarely endoscopic retrograde cholangiopancreatography (ERCP). Furthermore, a detailed pain history is crucial. This information provides an excellent road-map as regards the location and extent of the disease process, as well as the status of endocrine and exocrine functions. It also enables the clinician to chart an appropriate treatment plan.