Pain and malabsorption are the major clinical problems to manage in patients with chronic pancreatitis. To successfully manage pain requires knowledge of the natural history of chronic pancreatitis; to manage malabsorption requires some information regarding the pathophysiology of pancreatic insufficiency and the behavior of enzymes within the intestinal lumen. Surprisingly, all too often this knowledge is lacking and leads to inappropriate and ill-advised or improper treatments. Herein is reviewed the author’s current opinion regarding treatment of these problems, based on natural history and pathophysiologic studie