Interpretation of the 2026 European multidisciplinary guidelines on pain management in acute pancreatitis_West China Medical Journal

Authors：

CAI Wenhao ¹ , LIU Fei ² , DING Ling ^3,4 , LI Shuang ⁵ , CHEN Weiwei ⁶ , ZHANG Hong ⁷ , LI Jianing ⁸ , GAO Lin ⁹ , CUI Yunfeng ¹⁰ , ZHAO Xiaolei ¹¹ , WANG Gang ¹² , WANG Wen ⁴ , DENG Lihui ¹ , KE Lu ⁹ ,  HE Wenhua ³ ,  HUANG Wei ¹

1. West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P. R. China;
4. Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
5. Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P. R. China;
6. Medical College of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225200, P. R. China;
7. Medical Experiment Center, Shaanxi University of Chinses Medicine, Xianyang, Shaanxi 712046, P. R. China;
8. Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P. R. China;
9. Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210016, P. R. China;
10. Department of Hepatobiliary and Pancreatic Surgery, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin 300100, P. R. China;
11. Department of Gastroenterology, People’s Hospital, Peking University, Beijing 100044, P. R. China;
12. Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P. R. China;

Corresponding?author：

HE Wenhua, Email: hewenhua@ncu.edu.cn; HUANG Wei, Email: wei.huang.scu@vip.163.com

Keywords：

Acute pancreatitis; pain management; opioids; epidural analgesia; guideline interpretation

DOI：

10.7507/1002-0179.202606167

Video：

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Abstract Full text Figures/Tables Video References Cited by

Pain is one of the main presenting symptoms in patients with acute pancreatitis (AP) and is also an important clinical factor affecting fluid resuscitation, enteral nutrition, early mobilization, organ support, and post-discharge recovery. The 2026 European interdisciplinary guidelines on pain management in AP were developed using a high-quality guideline development framework and generated 41 consensus-based recommendations across nine topics: general principles of acute pain management, pain pathophysiology, pain assessment, pharmacological treatment, epidural analgesia, complementary therapies, the impact of pain control on clinical outcomes, management of special populations, and discharge and follow-up. The key recommendations include that opioid use should not be delayed in patients with severe pain because of theoretical safety concerns; non-steroidal anti-inflammatory drugs generally do not increase adverse events or worsen AP severity; patient-controlled intravenous analgesia should not be used as a routine strategy; epidural analgesia may have potential benefits in severe AP; acupuncture and Chaiqin Chengqi decoction may be considered as limited adjunctive treatment options; and routine imaging follow-up is not supported for patients with pain after discharge, with selective investigations recommended based on clinical indications. This guideline interpretation discusses the key recommendations, evidence base, and implementation considerations in the context of clinical practice in China, aiming to provide a reference for standardizing AP pain management and optimizing patient outcomes.

Citation： CAI Wenhao, LIU Fei, DING Ling, LI Shuang, CHEN Weiwei, ZHANG Hong, LI Jianing, GAO Lin, CUI Yunfeng, ZHAO Xiaolei, WANG Gang, WANG Wen, DENG Lihui, KE Lu, HE Wenhua, HUANG Wei. Interpretation of the 2026 European multidisciplinary guidelines on pain management in acute pancreatitis. West China Medical Journal, 2026, 41(7): 1062-1070. doi: 10.7507/1002-0179.202606167 Copy

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2. Pandanaboyana S, Knoph CS, Olesen SS, et al. Opioid analgesia and severity of acute pancreatitis: an international multicentre cohort study on pain management in acute pancreatitis[J]. United European Gastroenterol J, 2024, 12(3): 326-338.
3. IAP/APA/EPC/IPC/JPS Working Group. International Association of Pancreatology Revised Guidelines on Acute Pancreatitis 2025: supported and endorsed by the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society[J]. Pancreatology, 2025, 25(6): 770-814.
4. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis[J]. Pancreatology, 2013, 13(4 Suppl 2): e1-e15.
5. Pandanaboyana S, Knoph CS, Kuhlmann L, et al. European interdisciplinary guidelines on pain management in acute pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG evidence-based recommendations[J]. United European Gastroenterol J, 2026, 14(5): e70230.
6. Thavanesan N, White S, Lee S, et al. Analgesia in the initial management of acute pancreatitis: a systematic review and meta-analysis of randomised controlled trials[J]. World J Surg, 2022, 46(4): 878-890.
7. Cai W, Liu F, Wen Y, et al. Pain management in acute pancreatitis: a systematic review and meta-analysis of randomised controlled trials[J]. Front Med (Lausanne), 2021, 8: 782151.
8. Al-Leswas D, Baxter N, Lim WB, et al. The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis[J]. HPB (Oxford), 2023, 25(2): 162-171.
9. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council[J]. J Pain, 2016, 17(2): 131-157.
10. Huang Y, Badurdeen DS. Acute pancreatitis review[J]. Turk J Gastroenterol, 2023, 34(8): 795-801.
11. Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156(7): 2008-2023.
12. Barreto SG, Saccone GT. Pancreatic nociception--revisiting the physiology and pathophysiology[J]. Pancreatology, 2012, 12(2): 104-112.
13. Wu Y, Han C, Luo R, et al. Molecular mechanisms of pain in acute pancreatitis: recent basic research advances and therapeutic implications[J]. Front Mol Neurosci, 2023, 16: 1331438.
14. Liddle RA. The role of transient receptor potential vanilloid 1 (TRPV1) channels in pancreatitis[J]. Biochim Biophys Acta, 2007, 1772(8): 869-878.
15. Vera-Portocarrero L, Westlund KN. Role of neurogenic inflammation in pancreatitis and pancreatic pain[J]. Neurosignals, 2005, 14(4): 158-165.
16. Liddle RA, Nathan JD. Neurogenic inflammation and pancreatitis[J]. Pancreatology, 2004, 4(6): 551-560.
17. Kuhlmann L, Olesen SS, Drewes AM. Assessment of visceral pain with special reference to chronic pancreatitis[J]. Front Pain Res (Lausanne), 2022, 3: 1067103.
18. Bigalke S, Mae?en TV, Schnabel K, et al. Assessing outcome in postoperative pain trials: are we missing the point? A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty[J]. Pain, 2021, 162(7): 1914-1934.
19. Mae?en TV, Austenfeld E, Kaiser U, et al. Systematic review on pain-related outcome domains after sternotomy: a first step toward the development of a core outcome set[J]. Value Health, 2021, 24(8): 1203-1212.
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