Nerve block technique provides sustained relief of pancreatic cancer pain

Neurolytic celiac plexus block (NCPB) can relieve the intense pain associated with pancreatic cancer to a greater degree and for a longer period of time than traditional optimized systemic analgesic therapy (SAT), according to results of a controlled trial conducted at the Mayo Clinic in Rochester, Minnesota.

“Pancreatic cancer is notorious for being associated with terrible pain and median survival is only 6 months from diagnosis in unresectable cases,” Dr. Gilbert Y. Wong, a Mayo Clinic anesthesiologist specializing in pain medicine, told Reuters Health. “In this study, we confirmed our clinic experience that neurolytic celiac plexus block may allow these patients to live more comfortably, often for the remainder of their lives.” In the study, reported in the March 3 issue of the Journal of the American Medical Association, Dr. Wong and colleagues randomly assigned 100 patients with advanced unresectable pancreatic cancer with significant pain of similar intensity to receive either NCPB or SAT with a sham injection. Subsequently, all patients could receive additional opioids as needed. All of the patients were followed until death or for at least one year after enrolling in the study. During the first week after randomization, patients in both groups reported less intense pain but patients receiving the neural block had a significantly larger decrease from baseline in pain intensity (53%) than patients receiving SAT (27%). Repeated measures through the first six months after treatment showed that NCPB patients continued to have significantly lower levels of pain than SAT patients. “With NCPB, the injected substances destroy the nerve centers responsible for pain transmission for the majority of upper abdominal visceral pain so the effect can be potentially long lasting and that is in fact what we found,” Dr. Wong explained to Reuters Health. Quality of life also improved during the first week in both arms, but gradually declined with time. The consumption of opioids and survival were not markedly different between the two study arms. ]The findings of this study indicate that the nerve block technique “should be considered a treatment option” for pancreatic cancer pain, Dr. Wong said. “Other types of upper abdominal cancer-related pain may potentially be amenable to this type of nerve block technique as well,” he added. “However, a randomized clinical trial would be needed to definitively demonstrate this.” (Source: JAMA 2004;291:1092-1099: Reuters Health: Megan Rauscher: March 2004: Oncolink)