Pain Management for Hepatobiliary Cancer

Abstract

Although many options exist to address hepatobiliary cancer-induced pain, it remains undertreated and has an adverse impact on quality of life. Fortunately, if addressed appropriately, the majority of patients can be treated successfully. This pain may be nociceptive, neuropathic, or a combination of the two. A multimodality approach including oral and intravenous opioid and non-opioid medications, and interventional approaches including celiac plexus blocks and implantation of drug delivery systems for intrathecal delivery of opioids can be considered and utilized as appropriate. We review the pathophysiology of pain, the approach to correctly diagnosing the different types of pain, the appropriate treatment recommendations, and how to avoid and address the common side effects resulting from these treatments.

Celiac plexus neurolysis for abdominal cancers: going beyond pancreatic cancer pain

“…With hepatobiliary cancer cases now found to have the fastest-growing cancer death rate in the United States, it is even more imperative to understand if interventional pain therapies such as CPN can be used to reduce symptomatology in this group. 7 , 16 Similarly, with the dismal prognosis of even early-stage pancreatic cancers, the potential benefit of CPN seen in late-stage pancreatic cancers may still be relevant for early-stage pancreatic cancers. 4 , 5 , 15 , 18 , 20 , 24 Because of the anatomy of the celiac plexus, we believe that hepatobiliary, early-stage pancreatic, and NPNH-gastrointestinal cancer patients all have an opportunity to benefit from CPN and hope that future studies are conducted with larger populations of these patients.…”

“…The handful that have broached the subject are equally limited for sample size but have shown results that prompt additional research. 5 – 7 , 10 , 11 , 15 …”

“…The handful that have broached the subject are equally limited for sample size but have shown results that prompt additional research. [5][6][7]10,11,15 This retrospective study analyzed data from 173 patients at a single hospital to identify which cancers benefit, which symptoms improve, and which stages are best to provide the procedure to patients suffering from unresectable abdominal malignancies.…”

Pain management and palliative care in pancreatic cancer

“…27 Von Guten et al 28 describe a 7-step approach for physicians for structuring communication regarding care at the end of life. Physicians should (1) prepare for discussions by confirming medical facts and establishing an appropriate environment, (2) establish what the patient (and family) knows by using openended questions, (3) determine how information is to be handled, (4) deliver the information in a sensitive but straightforward manner, (5) respond to emotions of the patients and families, (6) establish goals for care and treatment priorities, and (7) establish an overall plan. These 7 steps can be used when delivering difficult news, discussing advance care planning, managing conflict, eliciting preferences in care, and discussing death.…”

Avaliação e mensuração da dor crônica advinda do câncer

“…Abundante literatura sobre a dor do câncer há disponível em nosso meio (APOLONE et al, 2009;BASTOS et al, 2009;BORNEMAN et al, 2010;BOUREAU et al, 2001;BRUNELLI et al, 2010;CAPONERO, 2008;CARACENI, 2001CARACENI, , 2005CHIH-YI SUN et al, 2007;COLVIN;FALLON, 2008;COUCEIRO;MENEZES;VALENÇA, 2009;HADI et al, 2008;DUGGLEBY, 2002;EDRINGTON et al, 2007;FERREL;MICHAEL;PAICE, 2008;FOLEY, 1999;HALPERT;ERDEK, 2008;JACOBSEN et al, 2009;JENSEN, 2003;KATZ et al, 2005;KLEPSTAD et al, 2002;MACDONALD et al, 2005;MANTYH et al, 2002;MARINEO, 2003;MIASKOWSKI et al, 2007;MICELLI, 2002;MYSTAKIDOU et al, 2007;PERRON;SCHONWETTER, 2001;PIMENTA et al, 2006;PITORAK, 2005;POLESHUCK et al, 2006;PORTENOY, 1999;RIPPAMONTI;LONGO, 2004;STENSETH et al, 2007; VAN DEN BEUKEN VAN EVERDIGEN et al, 2007;VILA et a...…”