Pancreas Cancer-Associated Pain Management

Abstract

Pain is highly prevalent in patients with pancreas cancer and contributes to the morbidity of the disease. Pain may be due to pancreatic enzyme insufficiency, obstruction, and/or a direct mass effect on nerves in the celiac plexus. Proper supportive care to decrease pain is an important aspect of the overall management of these patients. There are limited data specific to the management of pain caused by pancreatic cancer. Here we review the literature and offer recommendations regarding multiple modalities available to treat pain in these patients. The dissemination and adoption of these best supportive care practices can improve quantity and quality of life for patients with pancreatic cancer. IMPLICATIONS FOR PRACTICE: Pain management is important to improve the quality of life and survival of a patient with cancer. The pathophysiology of pain in pancreas cancer is complex and multifactorial. Despite tumor response to chemotherapy, a sizeable percentage of patients are at risk for ongoing cancer-related pain and its comorbid consequences. Accordingly, the management of pain in patients with pancreas cancer can be challenging and often requires a multifaceted approach.

Keywords: Pain management; Palliative care; Pancreatic neoplasms.

Figure 1

Available modalities for management of pancreas cancer pain are stacked in boxes along the x‐axis, which depicts increasing pain intensity from left to right. The boxes are “stacked” to show that pain management modalities can be used throughout the patient's clinical course and that to achieve optimal relief, pain treatment can be switched or continued as a modality is added, usually from a higher box, or one listed to the right. The dark purple boxes contain pain treatment modalities that are considered standards of care. The light purple boxes contain pain treatment modalities that are currently considered experimental. Neurolysis includes celiac and splanchnic plexus or nerve blocks.Abbreviations: APAP, acetaminophen; COX‐2i, cyclooxygenase‐2 inhibitor; HIFU, high‐intensity focused ultrasound; IT, intrathecal; TENS, transcutaneous electrical nerve stimulation.