As has been the case for decades, the indication for surgery in the CP patient remains to treat pain or complications (e.g., bile duct obstruction, gastric outlet obstruction). Drainage procedures will allow preservation of pancreatic parenchyma with its exo­crine and endocrine function compared to surgical resection, but there is no good data to support the suggestion that drainage procedures will allow for reversal of EPI or endocrine already lost. As such, it is important that the pancreatic surgeon counsel the patient and caregivers carefully with regard to the specic indication for surgery. The authors are careful to be very specic in the expectations for resolution of pain. In addition to the type of surgery performed, the pathophysiology of pain in a specic patient and abstinence from alcohol and tobacco play a major role in pain score improvement following surgery and duration of that improvement. The pain relief will take months and the patient must be prepared for this slow weaning off pain medications. This is a process that will be frustrating for all involved and clear expectations must be laid out at the start of the surgery planning. The authors will increase the dosing of gabapentin to 300mg TID to maximize non-narcotic effects and nerve stabilizing effects. They will also add an SSRI, where appropriate, and try to encourage the patient and family to seek counseling for non-pharmacologic mea­sures that can be very helpful. Working with a pain management physician is very helpful. However, this has become a real challenge as many anesthesia-pain man­agement doctors have closed their practices in the private world. The surgeon who deals with these patients must have a working knowledge of pain management. Typically, the author will maximize non-narcotic medications. They will then add a shorter acting narcotic and eventually ramp up to a long-acting agent (usually fen­tanyl patch that lasts for 3days with a constant level of drug), an intermediate acting agent, such as oxycontin ER, which lasts for 12h, and a shorter acting agent that will be used for breakthrough pain, such as hydrocodone. The plan for weaning will be to gradually decrease the longest acting agent rst and gradually work down to the short-acting agent. The aim is to gradually close the patients “pain gates” that have been wide open for a while with their chronic pain. The patients are counseled about the importance of quitting alcohol prior to surgical intervention. Smoking cessation is paramount to successful outcome and is considered a requirement by the authors prior to surgical intervention in CP patients.