- Design
- 24-week double-blind, placebo-controlled randomised trial
- Population
- 107 adults with chronic pancreatitis and chronic abdominal pain
- Primary outcome
- Change in Izbicki pain score at 12 weeks
- Effect
- Between-group difference -2.5 (95% CI -9.3 to 4.2), p=0.49
Pancreatic enzyme replacement is sometimes given for pain in chronic pancreatitis on the theory that it rests the gland, but the evidence has been weak. This double-blind trial from two Indian academic centres tested it properly, randomising 107 adults with painful chronic pancreatitis to non-enteric-coated enzymes or placebo for 12 weeks.
There was no analgesic benefit. The change in the Izbicki pain score did not differ between groups at 12 weeks (between-group difference -2.5, 95% CI -9.3 to 4.2), and results were similar at 24 weeks and across secondary pain measures. Adverse events were mild and comparable.
The practical message is not to prescribe pancreatic enzymes to treat pain in chronic pancreatitis. They remain indicated for exocrine insufficiency with steatorrhoea and weight loss, but pain relief is not a reason to start or continue them, and other analgesic and interventional strategies should be pursued instead.
- Double-blind randomised trial of 107 adults with painful chronic pancreatitis in India.
- Non-enteric-coated pancreatic enzymes were compared with placebo for 12 weeks.
- There was no difference in pain improvement (Izbicki difference -2.5, 95% CI -9.3 to 4.2).
- Results were similar at 24 weeks and across secondary pain measures.
- Enzymes remain indicated for exocrine insufficiency, not for pain.
Why it matters
It closes off a common but unsupported use of enzymes, redirecting effort to treatments that address the pain.
Don't overread it
This tested enzymes for pain only; it does not question their established role in treating exocrine insufficiency with steatorrhoea.
The statistics, in plain English
A between-group difference of -2.5 on the Izbicki score with a confidence interval from -9.3 to 4.2 crosses zero, meaning no analgesic effect was detected. The trial was designed to find a clinically relevant difference, so its absence is informative.
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