Opioid Nonresponsiveness in Cancer Pain Can Be Reversible. A Serendipitous Conclusion of a Retrospective Analysis

Arcuri, Edoardo; Mercadante, Sebastiano; Laurenzi, L; Natoli, S; Centulio, F.; Fusco, Gianfranco; Ginobbi, Patrizia; Tirelli, Walter

doi:10.1016/s0885-3924(00)00226-8

Cited by 2 publications

(1 citation statement)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the meantime, somatic structures may be progressively involved due to invasion of peritoneum and/or abdominal wall or diaphragm. 16 Thus, the evolution is unpredictable, and based on individual anatomical factors due to the characteristics of local progression of disease. In a study focusing on the efficacy of NCPB in varying locations of pancreatic cancer, neurolysis was more effective in cases with tumor involving the head of the pancreas than in patients with cancer of the body and tail of the pancreas.…”

Section: Discussionmentioning

confidence: 99%

Celiac plexus block for pancreatic cancer pain: factors influencing pain, symptoms and quality of life

Mercadante

Català²,

Arcuri³

et al. 2003

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

Neurolytic celiac plexus block (NCPB) is claimed to be an effective method of pain control for pancreatic cancer pain. However, the factors that may influence long-term analgesia, adverse effects, and quality of life after performing NCPB have never been determined. In a prospective multicenter study, 22 patients who underwent NCPB were followed until death. Numerous parameters other than pain and symptom intensity were evaluated, including age, gender, initial site of cancer, sites of pain, possible peritoneal involvement, technique, and oncologic interventions. Indices were calculated to determine the opioid consumption ratio (EAS) and the trend of opioid escalation (OEI). NCPB was effective in reducing opioid consumption and gastrointestinal adverse effects for at least 4 weeks. In the last four weeks prior to death, there was the typical trend of increasing symptom intensity common to the terminal cancer population. None of the factors studied influenced the analgesic effectiveness of NPCB. NPCB, performed by skilled clinicians, regardless of the technique chosen, is a safe and useful means that should be considered as an adjuvant to common analgesic regimens at any stage, as it may allow the reduction of the visceral component of pancreatic pain that may prevail in certain phases of the illness. The analgesic and symptomatic effect of NCPB is presumably advantageous for about four weeks. A possible factor interfering with long-term outcome includes the capacity of cancer to involve the celiac axis, which can distort the anatomy and prevent neurolytic spread, or modify the pain mechanisms. Outcomes are strongly based on individual variation.

show abstract

Section: Discussionmentioning

confidence: 99%