Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain

Abstract

Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block (CPB) on pain relief and quality of life (QOL), compared to the traditional NSAID-morphine treatment. The criteria were morphine consumption, visual analogue pain scale (VAS), performance status (PS) determined by medical and nursing staffs, and answers to QOL questionnaires. Morphine consumption, VAS, PS, and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control. Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter. CPB was performed within 2-3 days after the control measurement. The VAS scores of the patients receiving CPB (n = 10) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the standard NSAID-morphine treatment (n = 11) during the same time period after the control measurement. Morphine consumption was significantly lower in weeks 4-7 (inclusive) following the procedure in the CPB group and continued to be lower thereafter, though not significantly so. Although the PS score slightly improved at the 2nd week after CPB, it was not improved by the start of the NSAID-morphine treatment. Self-assessed QOL scores did not ameliorate statistically after CPB; however, they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods, while they deteriorated only slightly in the CPB group. There were fewer side effects after CPB. These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain, but it may prevent deterioration in QOL by the long-lasting analgesic effect, limitation of side effects and the reduction of morphine consumption, compared to treatment only with NSAID-morphine.

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

“…A randomized placebo-controlled trial of intraoperative CPB in patients with pancreatic cancer showed lower pain scores in the treatment group throughout the follow-up [1]. Others confirmed lower pain scores after percutaneous CPB in patients not undergoing operation [2,3,4,5,6]. …”

“…These interventions have been shown to produce substantial reductions in pain scores in uncontrolled studies [4,5,11,16]. There are no randomized data for TS, but several randomized trials of CPB have shown lower pain scores compared with MM alone [2,3,6]. The most recent [6] was also the most relevant to our study: patients had protocol-driven MM, and the trial was double blinded, by the use of a placebo injection.…”

Celiac Plexus, Splanchnic Nerve Block, and Neurolysis

“…Kawamata et al [ 38 ] found a delayed but signi fi cant reduction in opioid requirement 4-7 weeks after neurolysis and that consumption continued to decrease over time. Another study found that celiac plexus neurolysis caused a signi fi cant but not complete decrease in opioid consumption; patients experienced a mean reduction of 40-80 mg/day of oral morphine [ 4 ] .…”

“…Multiple studies were unable to fi nd statistically signi fi cant differences between medically managed patients and patients who underwent neurolysis, when evaluating quality of life [ 6,34,38 ] . However, the results from Kawamata et al [ 38 ] indicate celiac plexus blockade does not directly improve quality of life in patients with pancreatic cancer pain, but it may prevent deterioration in quality of life by the long-lasting analgesic effect, limitation of side effects, and reduction of morphine consumption, compared to treatment only with NSAIDs and morphine.…”

Palliative Care in Pancreatic Cancer

“…In most cases, analgesic responses are high (>50%) with a wide range of duration. 41 No controlled trials have been conducted in which conventional pain management is compared to neurolytic intervention. Complications are usually mild, but in rare cases the procedure can cause significant complications, including pneumothorax, paraplegia, and ischemic gangrene of the bowel.…”