# The Author(s) 2010. This article is published with open access at Springerlink.com Background Unraveling the mechanisms of pain in chronic pancreatitis (CP) remains a true challenge. The rapid development of pancreatic surgery in the twentieth century, usage of advanced molecular biological techniques, and emergence of clinician-scientists have enabled the elucidation of several mechanisms that lead to the chronic, complicated neuropathic pain syndrome in CP. However, the proper analysis of pain in CP should include three main arms of mechanisms: “peripheral nociception, ” “peripheral/pancreatic neuropathy and neuroplasticity,” and “central neuropathy and neuroplasticity.” Discussion According to our current knowledge, pain in CP involves sustained sensitization of pancreatic peripheral nociceptors by neurotransmitters and neurotrophic factors following neural damage. This peripheral pancreatic neuropathy leads to intrapancreatic neuroplastic alterations that involve a profound switch in the autonomic innervation of the human pancreas via “neural remodeling. ” Furthermore, this neuropathy entails a hyperexcitability of spinal sensory second-order neurons, which are subject to modulation