Neural Sensitisation and Neuropsychological Alterations in Painful Chronic Pancreatitis

Chronic pancreatitis (CP) is a progressive inflammatory disease in which chronic abdominal pain affects up to 80% of patients and remains difficult to manage despite treatment of pancreatic pathology. Increasing evidence suggests that persistent pain is not solely driven by peripheral pancreatic abnormalities but also by central sensitization, involving maladaptive changes in central nervous system pain-processing pathways. While altered brain connectivity and neurochemical changes have been demonstrated in other chronic pain disorders, these mechanisms remain poorly characterized in CP. This study aims to integrate clinical phenotyping with blood-based metabolite profiling and advanced neuroimaging, including resting-state functional MRI and magnetic resonance spectroscopy, to investigate the relationship between central sensitization, brain dysfunction, and neuropsychological alterations. The findings may identify objective neurobiological markers of pain and facilitate the development of mechanism-based, personalized treatment strategies for patients with chronic pancreatitis.

Inclusion Criteria: * Diagnosed with CP confirmed by CECT, MRCP, or EUS based on Cambridge or Rosemont criteria. * Age 18-60 years. * Both genders Exclusion Criteria: * Recent episode of acute pancreatitis or ongoing pain (VAS \>5). * Pancreatic cancer and other significant comorbidities. * Recent use of antidepressants, anxiolytics, high-potency opioids, or neuromodulators. * Pregnancy and lactation. * Inability to give informed consent.