Patients with severe abdominal pain secondary to chronic pancreatitis may have minimal or no radiographic abnormalities (as shown by ultrasound, computed tomography, or endoscopic retrograde cholangiopancreatography), yet have abnormal exocrine function and histologic lesions. Pancreatic interstitial pressure may be increased without main duct dilation. Diffuse small duct disease may be responsible for abdominal pain. Endoscopic procedures for benign pancreatic disease remain experimental therapies and may cause permanent damage to the pancreas. No double-blind, placebo-controlled studies are available to demonstrate that these procedures relieve abdominal pain in chronic pancreatitis patients. Octreotide administered perioperatively prevents complications caused by pancreatic surgery. The standard aggressive interventional approach to the management of pancreatic pseudocysts may have to be reassessed because recent evidence suggests that conservative, expectant management may be the treatment of choice for many patients. This review focuses on recent observations concerning the pathogenesis, pathophysiology, diagnosis, and management of patients with chronic pancreatitis related to alcohol and cystic fibrosis, or idiopathic in nature.