The pathogenesis of pain in chronic pancreatitis is multifactorial and not totally clear. No therapy offers relief from pain in all patients, underlining individual differences in the causation of pain. The most prudent and simplest advice to patients is to abstain from alcohol use. However, despite the logical strength of the advice, even the value of abstinence in the prevention of or relief from abdominal pain is questioned. In this editorial, I summarize the pathogenesis of pain and attempt to explain the scientific basis for our failure to manage pancreatic pain satisfactorily.