Celiac plexus block increases quality of life in patients with pancreatic cancer

Abstract

Background: Pancreatic cancer is a malignant disease with a high mortality rate and severe pain that is challenging to manage. To reduce the excruciating abdominal pain, opioids and adjuvant agents are conventionally used.

Objectives: PRNCPB is a treatment of neural therapy. The number of studies assessing the effect on patients' QoL is limited and inconsistent. With this study, we intended to address this issue.

Study design: A prospective nonrandomized study with a series of cases of unresectable pancreatic cancer was conducted.

Setting: The study was performed at our pain clinic under real life conditions.

Materials and methods: A total number of 16 patients with severe abdominal pain were enrolled in the study all of whom had responded to combined systemic analgesic therapy inadequately and had intolerable side effects contraindicating further increase in dose. The efficacy of this invasive, palliative analgesic procedure was evaluated 35 days after PRNCPB was performed. Primary outcomes were changed in pain intensity using the VAS questionnaire. Secondary outcomes were improved in QoL using the SF-36 questionnaire. Changes in pain medications and adverse reactions were monitored.

Results: After PRNCPB patients experienced a significant decrease (P=0.002) in pain intensity as shown by the VAS score, and a decreased opiate demand. Their QoL scores considering effect sizes also improved (P<0.001). No complications attributable to PRNCPB were observed during the study period. Additionally, no adverse drug reactions were observed.

Limitations: Detection, observation, and reporting bias can be estimated as moderate. Selection bias was not detected.

Conclusion: Our results give preliminary evidence that PRNCPB might be helpful as an additional treatment to conventional pain management in end-stage pancreatic cancer patients. PRNCPB seems to improve QoL in these patients in a time frame of at least 5 weeks after intervention.

Keywords: cancer pain; celiac plexus; neural therapy; palliative care; pancreatic cancer; plexus block; quality of life.

Figure 1

Anatomy of percutaneous retrocrural neurolytic celiac plexus block.

Figure 2

Pain intensity on VAS scale before and after treatment.

Figure 3

SF-36 dimensions before and after treatment. Abbreviations: GH, general health perceptions; MH, mental health, emotional well-being; FP, physical functioning, physical health problems; RE, emotional role functioning, emotional health problems; RP, physical role functioning; SF, social role functioning; VT, vitality, energy/fatigue.