Treatment Of Pancreatic Cancer Pain Research Articles

The combined analgesic effect of pregabalin and morphine in the treatment of pancreatic cancer pain, a retrospective study.

BackgroundPregabalin is commonly used to relieve neuropathic pain. However, data are lacking on its efficacy for the treatment of chronic cancer pain. The purpose of this study was to determine the analgesic efficacy of pregabalin combined with morphine in the management of pancreatic cancer pain.MethodsThis study reviewed patients who were prescribed morphine and 150 mg/d pregabalin between 1 January 2017 and 10 November 2018 in our institute. The primary outcomes of this study were the average pain score and dose of morphine. Secondary outcomes included characters of breakthrough cancer pain, functional interference related to pain, anxiety/depression status, and incidence of treatment‐related adverse events during the study.ResultsA total of 240 patients with pain related to pancreatic cancer were included in the study. The results showed that patients of both combination therapy group (pregabalin+morphine) and monotherapy group (morphine) achieved similar analgesic efficacy, demonstrated by NRS (2.4 ± 0.9 vs. 2.6 ± 0.9; combination vs. monotherapy) at the end of the study. Mean daily dose of morphine used in the combination group was significant lower compared to monotherapy group (39.5 ± 16.0 mg vs. 61.5 ± 19.3 mg, net difference 23.5, 95% CI: 18.4–28.6, p < 0.001). The change of functional interference score related to pain was significantly different between combination and monotherapy group (12.0 ± 0.4 vs. 9.8 ± 4.9; net difference, 2.3; 95% CI: 1.1–3.3; p < 0.001). Patients in combination therapy group had experienced shorter duration of breakthrough cancer pain than those in monotherapy group (X2 p < 0.001, Cramer's V:0.36). The incidence of somnolence, dizziness, and cognitive dysfunction were significantly higher in the combination group compared to monotherapy group. No serious treatment‐related side effects were observed.ConclusionsThe findings of this study supported the use of pregabalin with morphine to relieve pain in patients of pancreatic cancer.

Neurolytic celiac plexus block for pancreatic cancer pain: A review of literature

The effective management of pancreatic cancer pain continues to be a major challenge for patients and clinicians. Up to 80% of patients with advanced pancreatic cancer present with the symptoms of severe pain. One of the most important goals in their management is achieving the highest quality of life throughout the course of disease with effective palliation of pain. Majority of the current data supports the use Neurolytic celiac plexus block (NCPB) and has been shown to be more effective in reducing pain compared with standard pharmacotherapy. NCPBs have led to decreased opioid requirements and related side effects, thus preventing deterioration in quality of life. In this article, we discuss the treatment of pancreatic cancer pain and the advances in techniques of performing NCPB. We also analyzed the incidence of complications and the quality of pain relief with the use of NCPB. NCPB is effective, has a low incidence of complications, and should be used more often in patients with pancreatic cancer pain.

Celiac plexus block in patients with nonpancreatic GI malignancies: Experience from a single institution.

e19551 Background: Celiac plexus block (CPB) has been well described in the treatment of pancreatic cancer pain. A recent Cochrane Library review of the subject concluded that CPB often resulted in fewer adverse effects when compared to chronic opioid use. CPB has not been well described in non-pancreatic GI malignancies. This study sought to determine the effectiveness of CPB in non-pancreatic GI malignancies. Methods: The Virginia Commonwealth University Massey Cancer Center database was queried for all patients who had undergone celiac plexus block, 2001-2010, using specific CPT billing codes. In addition, VCU Radiology Department records were also examined. Diagnosis, physician assessment of effectiveness, pre and post procedure pain scores, complications of procedure, and pain medication dosage pre and post procedure were all assessed. Results: 68 total patients were identified. 12 patients underwent a CPB for non-pancreatic GI malignancies and 56 for pancreatic cancer patients. The most common non-pancreatic GI malignancies were colorectal cancer (50%), hepatocellular carcinoma (8%), carcinoid (8%), duodenal cancer (8%), and gastric cancer (8%). By study criteria, 7 of the 12 patients had sufficient data for exploratory analysis. By physician assessment, CPB resulted in pain relief in 5 (71%) of 7 patients. Furthermore, the post procedure pain score improved but the usage of pain medications did not change. By comparison, 26 of 56 patients with pancreatic CA had sufficient data and 15(58%) has pain relief by physician assessment. Conclusions: CPB appears to provide some pain relief for patients with non-pancreatic GI malignancies. However, the retrospective design revealed missing data including: pre and post procedure pain scores, complications of procedure and patient assessments of pain. A prospective study is being considered.

Placebo response to interventional pain procedures and effect on patient outcome

Considerable debate exists over the effectiveness of numerous procedures performed in current interventional pain practice. Our goal was to review all current prospective, randomized, placebo-controlled trials pertaining to the most commonly performed interventional pain procedures and to present these results in the form of a comprehensive review article. A review of the literature was performed with extensive PubMed searches and no date restrictions. A review of various reference sections within articles was also done. All prospective, randomized, placebo-controlled trials acquired that pertained to the most commonly performed intervention pain medicine techniques were included in the review. Lumbar and transforaminal epidural steroid injections appear superior to placebo. Radiofrequency denervation and steroid injections for sacroiliac joint pain appear superior to placebo. Radiofrequency denervation for lumbar and cervical facetogenic pain appears superior to placebo. Intradiscal electrothermal therapy for discogenic low back pain may be more effective than placebo in a select group of patients. Alcohol neurolytic celiac plexus block appears superior to placebo in the treatment of pancreatic cancer pain. Current data do not support superiority over placebo for lumbar facet joint steroid injections, lumbar intradiscal steroid therapy, or vertebroplasty for treatment of osteoporotic fractures. A continued lack of prospective, randomized, placebo-controlled trials pertaining to interventional pain medicine still persists. The above results can only serve as a guide in current practice, as only tentative conclusions can be reached based on the current data.

The Role of Neurolytic Celiac Plexus Block in the Treatment of Pancreatic Cancer Pain

Pancreatic carcinoma, an important leading cause of cancer death, has increased steadily in incidence and still has a poor prognosis. Pain is one of the most frequent symptoms, affecting more than 75% of patients. It is often present in the early stages of disease and may be severe and difficult to treat. Abdominal viscera, including pancreas, liver, gallbladder, adrenal, kidney, and the gastrointestinal tract from the level of the gastroesophageal junction to the splenic flexure of the colon are innervated, at least in part, via the celiac plexus. Thus, painful tumors in these viscera may have pain relieved through the use of a neurolytic celiac plexus block (NCPB). Although some investigators questioned the role and the efficacy of NCPB in the treatment of upper abdominal cancer pain, most of them have suggested that it may represent the optimal treatment, especially for pancreatic cancer pain. In this report we have reviewed the techniques, results, and complications of NCPB for the treatment of pancreatic cancer pain.

Pitfalls of DXA interpretations in lumbar spines

Considerable debate exists over the effectiveness of numerous procedures performed in current interventional pain practice. Our goal was to review all current prospective, randomized, placebo-controlled trials pertaining to the most commonly performed interventional pain procedures and to present these results in the form of a comprehensive review article. A review of the literature was performed with extensive PubMed searches and no date restrictions. A review of various reference sections within articles was also done. All prospective, randomized, placebo-controlled trials acquired that pertained to the most commonly performed intervention pain medicine techniques were included in the review. Lumbar and transforaminal epidural steroid injections appear superior to placebo. Radiofrequency denervation and steroid injections for sacroiliac joint pain appear superior to placebo. Radiofrequency denervation for lumbar and cervical facetogenic pain appears superior to placebo. Intradiscal electrothermal therapy for discogenic low back pain may be more effective than placebo in a select group of patients. Alcohol neurolytic celiac plexus block appears superior to placebo in the treatment of pancreatic cancer pain. Current data do not support superiority over placebo for lumbar facet joint steroid injections, lumbar intradiscal steroid therapy, or vertebroplasty for treatment of osteoporotic fractures. A continued lack of prospective, randomized, placebo-controlled trials pertaining to interventional pain medicine still persists. The above results can only serve as a guide in current practice, as only tentative conclusions can be reached based on the current data.

Pancreatic cancer survivorship: Intrathecal drug delivery system for pain management

14100 Background: Pancreatic cancer is predominantly unresectable at diagnosis and is most frequently fatal. Nationally the average survivorship is 10 months. Among pancreatic cancer patients, pain is associated with decreased survival rates. Quality of life and survivorship are the principal outcome measures for these patients. Successful pain management may be a significant predictor of prolonged survivorship. No study has demonstrated an impact on survivorship secondary to the treatment of pancreatic cancer pain and the use of Intrathecal Drug Delivery Systems (IDDS). Methods: A retrospective chart review identified all pancreatic cancer patients treated at a cancer pain treatment center between January 2002 and June 2005. 43 patients had known dates of diagnosis and known dates of death. The Arizona Department of Health Services Cancer Registry provided similar information for pancreatic cancer patients residing in Maricopa County for that time period. 713 Maricopa county residents had known dates of diagnosis and known dates of death. Results: Among the Maricopa County pancreatic cancer patients, the mean survivorship was 5 months. Among the treatement center patients who did not receive the IDDS for pain, 10 (23.3%), the mean survivorship was 10.8 months. Among the pancreatic cancer patients receiving IDDS for pain management, 33 (76.7%), the mean survivorship was 14.2 months. Mean survivorship among the treatment center patients receiving IDDS for pain management is nearly 3 times greater than the general survivorship of pancreatic cancer patients in Maricopa County. Among the treatement center patients the mean survivorship is nearly 50% greater for patients receiving IDDS versus those that did not. Conclusions: The implantable IDDS for pain management among pancreatic cancer patients may be a significant predictor of increased survivorship. A larger sample size may be needed to detect significant differences in survivorship. Controlled studies examining survivorship as the primary outcome for patients with unresectable pancreatic cancer by evaluating the implantable IDDS as compared to usual care modalities such as comprehensive medical management (CMM) or neurolytic celiac plexus block (NCPB) for pain management are warranted. No significant financial relationships to disclose.

(836): Pancreatic cancer survivorship: Intrathecal drug delivery system for pain management

Pancreatic adenocarcinoma is predominantly unresectable at diagnosis and is most frequently a fatal disease. Nationally the average survivorship is 10 months. Among pancreatic cancer patients, pain is associated with decreased survival rates. Quality of life and survivorship are the principal outcome measures for patients suffering from unresectable pancreatic cancer. Successful pain management may be a significant predictor of prolonged survivorship among pancreatic cancer patients. No study has demonstrated an impact on survivorship secondary to the treatment of pancreatic cancer pain and the use of the Intrathecal Drug Delivery System (IDDS). A retrospective chart review was conducted to identify all pancreatic cancer patients treated with IDDS at a cancer pain treatment center between January 2002 and June 2005. Forty three patients had known dates of diagnosis and known dates of death. The Arizona Department of Health Services (AZDHS) Cancer Registry provided similar information for pancreatic cancer patients residing in Maricopa County for that time period. 713 Maricopa county residents had known dates of diagnosis and known dates of death. Among the Maricopa County pancreatic cancer patients, the mean survivorship was 5 months. Among the VCPTC pancreatic cancer patients who did not receive the IDDS for pain, 10 (23.3%), the mean survivorship was 10.8 months. Among the VCPTC pancreatic cancer patients receiving the implantable IDDS for pain management, 33 (76.7%), the mean survivorship was 14.2 months. Mean survivorship among the VCPTC pancreatic cancer patients receiving the implantable IDDS for pain management is nearly 3 times greater than the general survivorship of pancreatic cancer patients in Maricopa County. Among the VCPTC patients the mean survivorship is nearly 50% greater for patients receiving the implantable IDDS for pain management versus those patients that did not. The implantable IDDS for pain management among pancreatic cancer patients may be a significant predictor of increased survivorship.

Surgical Diseases of the Pancreas (3rd Edition)

Surgical Diseases of the Pancreas (3rd Edition)