Is quality of life improved by neurolytic coeliac plexus block in pancreatic cancer pain management?

Abstract

Pancreatic cancer (PC) is a disease of insidious onset and late clinical presentation with an annual incidence of 100 per million population. Itis the sixth most common cause of mortality from cancer and records a median survival of about 3–6 months without treatment. Quality of life (QOL) is the major consideration in the management of advanced cancer. PC adversely affects QOL of sufferers and mostly presents with abdominal pain from intra- and extra-pancreatic origins. Opioids are the “Gold-standard” treatment in severe cancer pain management. However, its use may be challenged by debilitating side effects such as drowsiness, respiratory depression, constipation, nausea/vomiting, or opioid toxicity which further worsens QOL of patients burdened with cancer. Neurolytic coeliac plexus block (NCPB) is indicated in PC pain that is resistant or refractive to conventional analgesic methods. Such potent analgesic technique could ease the suffering of cancer patients and provides an improved QOL. Reports indicate that NCPB provides effective analgesia in advanced PC but might be associated with minor and transient side effects such as hypotension, diarrhea, and retroperitoneal hemorrhage. Reports from studies analyzed in this review show that NCPB provides superior analgesia in PC pain management than opioid-based therapies. However, there is no satisfactory evidence that NCPB improved QOL in these patients. This shows that QOL of advanced cancer patients is not synonymous with pain relief. Improvement in QOL will be difficult without management of the “total pain” felt by the patients.