No, bromelain is not like aspirin or Tylenol. It is an enzyme, not an anti-inflammatory. You don't take it when you need it. You take it all the time and regularly, like you would take glucosamine. I have been taking it every day since the end of July -- and am prepared to take it everyday forever if need be. So far I have seen absolutely no ill effects from it at all. If I miss two or three dosages though, I do start to notice a little more pain.
I do want to stress that it has not rendered me pain free -- although it has helped A LOT. It took between 1 and 2 weeks for me to start to notice the difference -- although it got progressively better after that time also.
I have no idea about pancreatin. I haven't tried it. I sort of figure -- why mess with success?
Finally -- I am not a devotee of a rigidly low-carb diet, like some folks on this board are. BUT -- I have also eliminated carbs through flour and wheat products. Literally, I eat no bread, pasta, or rice (not even brown rice although my pals tell me it will do no harm) and hardly ever eat junky snacks. (Well, in truth, once a week I will have a real sandwich with real bread -- but only once a week. I do eat carbs in fruits and in vegetables though -- I refuse to give up fruit. I also eliminated caffeine and I try to keep sugar to a bare minimum. And I am convinced it has also helped my feet tremendously. Personally, I think this is an ugly way to live -- it's really tough when you can't eat like a semi-normal person -- but it's 110% worth it to not have 24 hour pain.
I tend to try not to be fanatical in any part of my life -- but increasingly I find myself prone to strong dedication to bromelain and a low carb diet for my feet. I would definitely encourage people to try messing around (favorably) with what they eat as an influence. The bromelain is cheap (Vitamin Shoppe, 300 caps for less than $20)and the diet is nutritious so it's hard to lose.