A randomized clinical trial of nerve block to manage end-stage pancreatic cancerous pain
- 303 Downloads
- 4 Citations
Abstract
Pain control is the most difficult puzzle in patients with terminal pancreatic cancerous pain. Many methods in clinical practice fail in 20 ~ 50 % of patients. The present study aims to explore the effect of nerve block on patients with end-stage pancreatic cancerous pain. In this study, 100 subjects with end-stage pancreatic cancerous pain were enrolled and randomly assigned into two groups: 68 in nerve block group (N) and 32 in sham group (S). One group was treated with nerve block and the other group with sham procedure as controls. The pain score (by visual analog scale (VAS)), pain duration, reduction of other analgesic medications, and quality of life (with questionnaire QLQ) were evaluated before and 3 months after interventions. Comparisons were performed between before and after intervention in nerve block group and sham group. The results indicated that compared with sham group, the subjects in nerve block group had significant reduction with pain score, pain duration, and other analgesic medications, as well as improvement of quality of life (P < 0.05, respectively). In conclusion, nerve block is an effective method for treating patients with end-stage pancreatic cancerous pain.
Keywords
Nerve block Pancreatic cancerous pain Clinical trialNotes
Acknowledgments
The present study was supported by the Post-Graduate Scientific Research Innovation Project of Education Department of Jiangsu Province (CXZZ12_0842), China; the open fund of the Stem Cell and Biomedical Material Key Laboratory of Jiangsu Province (KJS1230), China; Science and Technology Research Project of Science, and Technology Bureau of Suzhou City (SYS201330), China.
Conflicts of interest
None
References
- 1.Papadopoulos D, Kostopanagiotou G, Batistaki C. Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-stage pancreatic abdominal cancer pain. Pain Physician. 2013;16(2):125–33.PubMedGoogle Scholar
- 2.Tschoep-Lechner KE, Milani V, Berger F, Dieterle N, Abdel-Rahman S, Salat C, et al. Gemcitabine and cisplatin combined with regional hyperthermia as second-line treatment in patients with gemcitabine-refractory advanced pancreatic cancer. Int J Hyperthermia. 2013;29(1):8–16.PubMedCrossRefGoogle Scholar
- 3.Rong Y, Wu W, Ni X, Kuang T, Jin D, Wang D, et al. Lactate dehydrogenase A is overexpressed in pancreatic cancer and promotes the growth of pancreatic cancer cells. Tumor Biol. 2013;34(3):1523–30.CrossRefGoogle Scholar
- 4.Mercadante S, Craig D, Giarratano A. US Food and Drug Administration's Risk Evaluation and Mitigation Strategy for extended-release and long-acting opioids: pros and cons, and a European perspective. Drugs. 2012;72(18):2327–32.PubMedCrossRefGoogle Scholar
- 5.Glaser SE, Goodman IJ, Broadnax JP. Concerns voiced over methadone results. Pain Physician. 2011;14(2):247–9.Google Scholar
- 6.Park BB, Yoon JS, Kim ES, Choi J, Won YW, Choi JH, et al. Inhibitory effects of eupatilin on tumor invasion of human gastric cancer MKN-1 cells. Tumor Biol. 2013;34(2):875–85.CrossRefGoogle Scholar
- 7.Ceelie I, de Wildt SN, van Dijk M, van den Berg MM, van den Bosch GE, Duivenvoorden HJ, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial. JAMA. 2013;309(2):149–54.PubMedCrossRefGoogle Scholar
- 8.Bektas M, Atiq M, Bhutani MS. First report of celiac plexus block for refractory abdominal pain secondary to peripancreatic colon cancer metastasis. Gastrointest Endosc. 2012;76(3):692–3.PubMedCrossRefGoogle Scholar
- 9.Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg. 2005;75(8):640–4.PubMedCrossRefGoogle Scholar
- 10.Wang X, Deng Y, Mao Z, Ma X, Fan X, Cui L, et al. CCN1 promotes tumorigenicity through Rac1/Akt/NF-kB signaling pathway in pancreatic cancer. Tumor Biol. 2012;33(5):1745–58.CrossRefGoogle Scholar
- 11.Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23(5):512–22.PubMedCrossRefGoogle Scholar
- 12.Johnson CD, Berry DP, Harris P, Pickering RM, Davis C, George S, et al. An open randomized comparison of clinical effectiveness of protocol-driven opioid analgesia, celiac plexus block or thoracoscopic splanchnicectomy for pain management in patients with pancreatic and other abdominal malignancies. Pancreatology. 2009;9(6):755–63.PubMedCrossRefGoogle Scholar
- 13.Yarmohammadi H, Nakamoto DA, Azar N, Hayek SM, Haaga JR. Percutaneous computed tomography guided cryoablation of the celiac plexus as an alternative treatment for intractable pain caused by pancreatic cancer. J Cancer Res Ther. 2011;7(4):481–3.PubMedCrossRefGoogle Scholar
- 14.Aprile G, Avellini C, Reni M, Mazzer M, Foltran L, Rossi D, et al. Biglycan expression and clinical outcome in patients with pancreatic adenocarcinoma. Tumor Biol. 2013;34(1):131–7.CrossRefGoogle Scholar
- 15.Xue YZ, Sheng YY, Liu ZL, Wei ZQ, Can HY, Wu YM, et al. Expression of NEDD9 in pancreatic ductal adenocarcinoma and its clinical significance. Tumor Biol. 2013;34(2):895–9.CrossRefGoogle Scholar
- 16.Levy MJ, Chari ST, Wiersema MJ. Endoscopic ultrasound-guided celiac neurolysis. Gastrointest Endosc Clin N Am. 2012;22(2):231–47.PubMedCrossRefGoogle Scholar
- 17.Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev. 2011;16(3):CD007519. doi: 10.1002/14651858.CD007519.pub2.
- 18.Liu TC, Hamitton N, Hawkins W, Gao F, Cao D. Comparison of WHO Classifications (2004, 2010), the Hochwald grading system, and AJCC and ENETS staging systems in predicting prognosis in locoregional well-differentiated pancreatic neuroendocrine tumors. Am J Surg Pathol. 2013;37(6):853–9.PubMedCrossRefGoogle Scholar
- 19.Lootens CC, Rapoff MA. Measures of pediatric pain. 21-numbered circle Visual Analog Scale (VAS), E-Ouch Electronic Pain Diary, Oucher, Pain Behavior Observation Method, Pediatric Pain Assessment Tool (PPAT), and Pediatric Pain Questionnaire (PPQ). Arthritis Care Res. 2011;63(S11):253–62.CrossRefGoogle Scholar
- 20.Gimeno-García AZ, Elwassief A, Paguin SC, Sahai AV. Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy. 2012;44(S2):267–76.Google Scholar
- 21.Djan R, Penington A. A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients. J Plast Reconstr Aesthet Surg. 2013;66(5):647–59.PubMedCrossRefGoogle Scholar
- 22.Andersson J, Angenete E, Gellerstedt M, Angeras U, Jess P, Rosenberg J, et al. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg. 2013;100(7):941–9.PubMedCentralPubMedCrossRefGoogle Scholar
- 23.Maruyama R, Suzuki H, Yamamoto E, Imai K, Shinomura Y. Emerging links between epigenetic alterations and dysregulation of noncoding RNAs in cancer. Tumor Biol. 2012;33(2):277–85.CrossRefGoogle Scholar
- 24.Bahn BM, Erdek MA. Celiac plexus block and neurolysis for pancreatic cancer. Curr Pain Headache Rep. 2013;17(2):310.PubMedCrossRefGoogle Scholar
- 25.Hilgier M, Rykowski JJ. One needle transcrural celiac plexus block. Single shot or continuous technique, or both. Reg Anesth. 1994;19(4):277–83.PubMedGoogle Scholar
- 26.Rykowski JJ, Hilgier M. Efficacy of neurolytic celiac plexus block in varying locations of pancreatic cancer: influence on pain relief. Anesthesiology. 2000;92(2):347–54.PubMedCrossRefGoogle Scholar
- 27.David Prologo J, Snyder LL, Cherullo E, Passalacgua M, Pirasteh A, Corn D. Percutaneous CT-guided cryoablation of the dorsal penile nerve for treatment of symptomatic premature ejaculation. J Vasc Interv Radiol. 2013;24(2):214–9.PubMedCrossRefGoogle Scholar
- 28.Kurup AN, Woodrum DA, Morris JM, Atwell TD, Schmit GD, Welch TJ, et al. Cryoablation of recurrent sacrococcygeal tumors. J Vasc Interv Radiol. 2012;23:1070–5.PubMedCrossRefGoogle Scholar
- 29.Wang DS, Zhang DS, Qiu MZ, Wang ZQ, Luo HY, Wang FW, et al. Prognostic factors and survival in patients with neuroendocrine tumors of the pancreas. Tumor Biol. 2011;32(4):697–705.CrossRefGoogle Scholar
- 30.Thakkar A, Sutaria D, Grandhi BK, Wang J, Prabhu S. The molecular mechanism of action of aspirin, curcumin and sulforaphane combinations in the chemoprevention of pancreatic cancer. Oncol Rep. 2013;29(4):1671–7.PubMedCentralPubMedGoogle Scholar
- 31.Li J, Chen X, Yang H, Wang X, Yuan D, Zeng Y, et al. Tumour cryoablation combined with palliative bypass surgery in the treatment of unresectable pancreatic cancer: a retrospective study of 142 patients. Postgrad Med J. 2011;87(1024):89–95.PubMedCrossRefGoogle Scholar
- 32.Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–25.PubMedGoogle Scholar
- 33.Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:560879.PubMedCentralPubMedGoogle Scholar
- 34.Iwata K, Yasuda I, Enya M, Mukai T, Nakashima M, Doi S, et al. Predictive factors for pain relief after endoscopic ultrasound-guided celiac plexus neurolysis. Dig Endosc. 2011;23(2):140–5.PubMedCrossRefGoogle Scholar
- 35.Spinks T, Albright HW, Feeley TW, Walters R, Burke TW, Aloia T, et al. Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America. Cancer. 2012;118(10):2571–82.PubMedCentralPubMedCrossRefGoogle Scholar
- 36.Basiński A, Stefaniak T, Stadnyk M, Sheikh A, Vingerhoets AJ. Influence of religiosity on the quality of life and on pain intensity in chronic pancreatitis patients after neurolytic celiac plexus block: case-controlled study. Relig Health. 2013;52(1):276–84.CrossRefGoogle Scholar
- 37.Cui L, Deng Y, Rong Y, Lou W, Mao Z, Feng Y, et al. IRF-2 is over-expressed in pancreatic cancer and promotes the growth of pancreatic cancer cells. Tumor Biol. 2012;33(1):247–55.CrossRefGoogle Scholar
- 38.Stefaniak T, Basinski A, Vingerhoets A, Makarewicz W, Connor S, Kaska L, et al. A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy. Eur J Surg Oncol. 2005;31(7):768–73.PubMedCrossRefGoogle Scholar