Browsing by Author "Trikudanathan, Guru"

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    Internet Cognitive-Behavioral Therapy for Painful Chronic Pancreatitis: A Pilot Feasibility Randomized Controlled Trial
    (Wolters Kluwer, 2021-06-18) Palermo, Tonya M.; Law, Emily F.; Topazian, Mark D.; Slack, Katherine; Dear, Blake F.; Ko, Yeon Joo; Vege, Santhi Swaroop; Fogel, Evan; Trikudanathan, Guru; Andersen, Dana K.; Conwell, Darwin L.; Yadav, Dhiraj; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC); Medicine, School of Medicine
    Introduction: Severe abdominal pain is a cardinal symptom of chronic pancreatitis (CP) associated with a high economic and societal burden. In other chronic pain conditions, cognitive-behavioral therapy (CBT) has demonstrated efficacy in improving patient outcomes (e.g., pain-related disability and depression). However, CBT has not yet been evaluated in adult patients with painful CP. We aimed to (i) evaluate the feasibility and acceptability of an adapted Internet CBT program for CP and (ii) generate pilot data regarding the effects of treatment on patient pain outcomes. Methods: Thirty adults (mean age = 49.8 years, SD = 12.5; 80% women) with suspected or definite CP were randomized to Internet CBT (Pancreatitis Pain Course) versus control. The Pancreatitis Pain Course has 5 CBT lessons (e.g., thought challenging, relaxation, and activity pacing) delivered over 8 weeks. Pain interference, pain intensity, and quality of life were assessed at pretreatment, posttreatment, and the 3-month follow-up. Qualitative interviews were conducted at posttreatment with a subset of participants. Results: Eighty percent of participants rated the program as highly acceptable; 64.3% completed all 5 lessons. Qualitative data revealed positive perceptions of program features, relevancy, and skills. Patients randomized to Internet CBT demonstrated moderate to large effects in reducing pain intensity and pain interference from baseline to 3 months. The proportion of treatment responders (>30% improvement) was significantly greater in the Internet-CBT group than in the control group (50% vs 13%, Fisher exact t test P = 0.04). Discussion: In this first trial of CBT pain self-management in CP, feasibility, acceptability, and preliminary efficacy for reducing pain and disability were demonstrated. Future definitive trials of CBT are needed.
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    Rationale and Design for the Diabetes RElated to Acute Pancreatitis and Its Mechanisms (DREAM) Study: A Prospective Cohort Study From the Type 1 Diabetes in Acute Pancreatitis Consortium (T1DAPC)
    (Wolters Kluwer, 2022) Hart, Phil A.; Papachristou, Georgios I.; Park, Walter G.; Dyer, Anne-Marie; Chinchilli, Vernon M.; Afghani, Elham; Akshintala, Venkata S.; Andersen, Dana K.; Buxbaum, James L.; Conwell, Darwin L.; Dungan, Kathleen M.; Easler, Jeffrey J.; Fogel, Evan L.; Greenbaum, Carla J.; Kalyani, Rita R.; Korc, Murray; Kozarek, Richard; Laughlin, Maren R.; Lee, Peter J.; Maranki, Jennifer L.; Pandol, Stephen J.; Evans Phillips, Anna; Serrano, Jose; Singh, Vikesh K.; Speake, Cate; Tirkes, Temel; Toledo, Frederico G. S.; Trikudanathan, Guru; Vege, Santhi Swaroop; Wang, Ming; Yazici, Cemal; Zaheer, Atif; Forsmark, Christopher E.; Bellin, Melena D.; Yadav, Dhiraj; Type 1 Diabetes in Acute Pancreatitis Consortium (T1DAPC); Medicine, School of Medicine
    Acute pancreatitis (AP) is a disease characterized by an acute inflammatory phase followed by a convalescent phase. Diabetes mellitus (DM) was historically felt to be a transient phenomenon related to acute inflammation; however, it is increasingly recognized as an important late and chronic complication. There are several challenges that have prevented precisely determining the incidence rate of DM after AP and understanding the underlying mechanisms. The DREAM (Diabetes RElated to Acute Pancreatitis and its Mechanisms) Study is a prospective cohort study designed to address these and other knowledge gaps to provide the evidence needed to screen for, prevent, and treat DM after AP. In the following article, we summarize literature regarding the epidemiology of DM after AP and provide the rationale and an overview of the DREAM study.