Skip to main content

Advertisement

Log in

A randomized clinical trial of nerve block to manage end-stage pancreatic cancerous pain

  • Research Article
  • Published:
Tumor Biology

Abstract

Pain control is the most difficult puzzle in patients with terminal pancreatic cancerous pain. Many methods in clinical practice fail in 20 ~ 50 % of patients. The present study aims to explore the effect of nerve block on patients with end-stage pancreatic cancerous pain. In this study, 100 subjects with end-stage pancreatic cancerous pain were enrolled and randomly assigned into two groups: 68 in nerve block group (N) and 32 in sham group (S). One group was treated with nerve block and the other group with sham procedure as controls. The pain score (by visual analog scale (VAS)), pain duration, reduction of other analgesic medications, and quality of life (with questionnaire QLQ) were evaluated before and 3 months after interventions. Comparisons were performed between before and after intervention in nerve block group and sham group. The results indicated that compared with sham group, the subjects in nerve block group had significant reduction with pain score, pain duration, and other analgesic medications, as well as improvement of quality of life (P < 0.05, respectively). In conclusion, nerve block is an effective method for treating patients with end-stage pancreatic cancerous pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Papadopoulos D, Kostopanagiotou G, Batistaki C. Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-stage pancreatic abdominal cancer pain. Pain Physician. 2013;16(2):125–33.

    PubMed  Google Scholar 

  2. Tschoep-Lechner KE, Milani V, Berger F, Dieterle N, Abdel-Rahman S, Salat C, et al. Gemcitabine and cisplatin combined with regional hyperthermia as second-line treatment in patients with gemcitabine-refractory advanced pancreatic cancer. Int J Hyperthermia. 2013;29(1):8–16.

    Article  PubMed  CAS  Google Scholar 

  3. Rong Y, Wu W, Ni X, Kuang T, Jin D, Wang D, et al. Lactate dehydrogenase A is overexpressed in pancreatic cancer and promotes the growth of pancreatic cancer cells. Tumor Biol. 2013;34(3):1523–30.

    Article  CAS  Google Scholar 

  4. Mercadante S, Craig D, Giarratano A. US Food and Drug Administration's Risk Evaluation and Mitigation Strategy for extended-release and long-acting opioids: pros and cons, and a European perspective. Drugs. 2012;72(18):2327–32.

    Article  PubMed  Google Scholar 

  5. Glaser SE, Goodman IJ, Broadnax JP. Concerns voiced over methadone results. Pain Physician. 2011;14(2):247–9.

    Google Scholar 

  6. Park BB, Yoon JS, Kim ES, Choi J, Won YW, Choi JH, et al. Inhibitory effects of eupatilin on tumor invasion of human gastric cancer MKN-1 cells. Tumor Biol. 2013;34(2):875–85.

    Article  CAS  Google Scholar 

  7. Ceelie I, de Wildt SN, van Dijk M, van den Berg MM, van den Bosch GE, Duivenvoorden HJ, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial. JAMA. 2013;309(2):149–54.

    Article  PubMed  CAS  Google Scholar 

  8. Bektas M, Atiq M, Bhutani MS. First report of celiac plexus block for refractory abdominal pain secondary to peripancreatic colon cancer metastasis. Gastrointest Endosc. 2012;76(3):692–3.

    Article  PubMed  Google Scholar 

  9. Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg. 2005;75(8):640–4.

    Article  PubMed  Google Scholar 

  10. Wang X, Deng Y, Mao Z, Ma X, Fan X, Cui L, et al. CCN1 promotes tumorigenicity through Rac1/Akt/NF-kB signaling pathway in pancreatic cancer. Tumor Biol. 2012;33(5):1745–58.

    Article  CAS  Google Scholar 

  11. Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23(5):512–22.

    Article  PubMed  Google Scholar 

  12. Johnson CD, Berry DP, Harris P, Pickering RM, Davis C, George S, et al. 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. Pancreatology. 2009;9(6):755–63.

    Article  PubMed  CAS  Google Scholar 

  13. Yarmohammadi H, Nakamoto DA, Azar N, Hayek SM, Haaga JR. Percutaneous computed tomography guided cryoablation of the celiac plexus as an alternative treatment for intractable pain caused by pancreatic cancer. J Cancer Res Ther. 2011;7(4):481–3.

    Article  PubMed  Google Scholar 

  14. Aprile G, Avellini C, Reni M, Mazzer M, Foltran L, Rossi D, et al. Biglycan expression and clinical outcome in patients with pancreatic adenocarcinoma. Tumor Biol. 2013;34(1):131–7.

    Article  CAS  Google Scholar 

  15. Xue YZ, Sheng YY, Liu ZL, Wei ZQ, Can HY, Wu YM, et al. Expression of NEDD9 in pancreatic ductal adenocarcinoma and its clinical significance. Tumor Biol. 2013;34(2):895–9.

    Article  CAS  Google Scholar 

  16. Levy MJ, Chari ST, Wiersema MJ. Endoscopic ultrasound-guided celiac neurolysis. Gastrointest Endosc Clin N Am. 2012;22(2):231–47.

    Article  PubMed  Google Scholar 

  17. Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev. 2011;16(3):CD007519. doi:10.1002/14651858.CD007519.pub2.

  18. Liu TC, Hamitton N, Hawkins W, Gao F, Cao D. Comparison of WHO Classifications (2004, 2010), the Hochwald grading system, and AJCC and ENETS staging systems in predicting prognosis in locoregional well-differentiated pancreatic neuroendocrine tumors. Am J Surg Pathol. 2013;37(6):853–9.

    Article  PubMed  Google Scholar 

  19. Lootens CC, Rapoff MA. Measures of pediatric pain. 21-numbered circle Visual Analog Scale (VAS), E-Ouch Electronic Pain Diary, Oucher, Pain Behavior Observation Method, Pediatric Pain Assessment Tool (PPAT), and Pediatric Pain Questionnaire (PPQ). Arthritis Care Res. 2011;63(S11):253–62.

    Article  Google Scholar 

  20. Gimeno-García AZ, Elwassief A, Paguin SC, Sahai AV. Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy. 2012;44(S2):267–76.

    Google Scholar 

  21. Djan R, Penington A. A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients. J Plast Reconstr Aesthet Surg. 2013;66(5):647–59.

    Article  PubMed  Google Scholar 

  22. Andersson J, Angenete E, Gellerstedt M, Angeras U, Jess P, Rosenberg J, et al. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg. 2013;100(7):941–9.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  23. Maruyama R, Suzuki H, Yamamoto E, Imai K, Shinomura Y. Emerging links between epigenetic alterations and dysregulation of noncoding RNAs in cancer. Tumor Biol. 2012;33(2):277–85.

    Article  CAS  Google Scholar 

  24. Bahn BM, Erdek MA. Celiac plexus block and neurolysis for pancreatic cancer. Curr Pain Headache Rep. 2013;17(2):310.

    Article  PubMed  Google Scholar 

  25. Hilgier M, Rykowski JJ. One needle transcrural celiac plexus block. Single shot or continuous technique, or both. Reg Anesth. 1994;19(4):277–83.

    PubMed  CAS  Google Scholar 

  26. Rykowski JJ, Hilgier M. Efficacy of neurolytic celiac plexus block in varying locations of pancreatic cancer: influence on pain relief. Anesthesiology. 2000;92(2):347–54.

    Article  PubMed  CAS  Google Scholar 

  27. David Prologo J, Snyder LL, Cherullo E, Passalacgua M, Pirasteh A, Corn D. Percutaneous CT-guided cryoablation of the dorsal penile nerve for treatment of symptomatic premature ejaculation. J Vasc Interv Radiol. 2013;24(2):214–9.

    Article  PubMed  CAS  Google Scholar 

  28. Kurup AN, Woodrum DA, Morris JM, Atwell TD, Schmit GD, Welch TJ, et al. Cryoablation of recurrent sacrococcygeal tumors. J Vasc Interv Radiol. 2012;23:1070–5.

    Article  PubMed  Google Scholar 

  29. Wang DS, Zhang DS, Qiu MZ, Wang ZQ, Luo HY, Wang FW, et al. Prognostic factors and survival in patients with neuroendocrine tumors of the pancreas. Tumor Biol. 2011;32(4):697–705.

    Article  Google Scholar 

  30. Thakkar A, Sutaria D, Grandhi BK, Wang J, Prabhu S. The molecular mechanism of action of aspirin, curcumin and sulforaphane combinations in the chemoprevention of pancreatic cancer. Oncol Rep. 2013;29(4):1671–7.

    PubMed Central  PubMed  CAS  Google Scholar 

  31. Li J, Chen X, Yang H, Wang X, Yuan D, Zeng Y, et al. Tumour cryoablation combined with palliative bypass surgery in the treatment of unresectable pancreatic cancer: a retrospective study of 142 patients. Postgrad Med J. 2011;87(1024):89–95.

    Article  PubMed  Google Scholar 

  32. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–25.

    PubMed  Google Scholar 

  33. Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:560879.

    PubMed Central  PubMed  Google Scholar 

  34. Iwata K, Yasuda I, Enya M, Mukai T, Nakashima M, Doi S, et al. Predictive factors for pain relief after endoscopic ultrasound-guided celiac plexus neurolysis. Dig Endosc. 2011;23(2):140–5.

    Article  PubMed  Google Scholar 

  35. Spinks T, Albright HW, Feeley TW, Walters R, Burke TW, Aloia T, et al. Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America. Cancer. 2012;118(10):2571–82.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Basiński A, Stefaniak T, Stadnyk M, Sheikh A, Vingerhoets AJ. Influence of religiosity on the quality of life and on pain intensity in chronic pancreatitis patients after neurolytic celiac plexus block: case-controlled study. Relig Health. 2013;52(1):276–84.

    Article  Google Scholar 

  37. Cui L, Deng Y, Rong Y, Lou W, Mao Z, Feng Y, et al. IRF-2 is over-expressed in pancreatic cancer and promotes the growth of pancreatic cancer cells. Tumor Biol. 2012;33(1):247–55.

    Article  CAS  Google Scholar 

  38. Stefaniak T, Basinski A, Vingerhoets A, Makarewicz W, Connor S, Kaska L, et al. A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy. Eur J Surg Oncol. 2005;31(7):768–73.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The present study was supported by the Post-Graduate Scientific Research Innovation Project of Education Department of Jiangsu Province (CXZZ12_0842), China; the open fund of the Stem Cell and Biomedical Material Key Laboratory of Jiangsu Province (KJS1230), China; Science and Technology Research Project of Science, and Technology Bureau of Suzhou City (SYS201330), China.

Conflicts of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Han Hong.

Additional information

Ling Gao, Yi-jin Yang, Hai-yan Xu, and Jin Zhou contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gao, L., Yang, Yj., Xu, Hy. et al. A randomized clinical trial of nerve block to manage end-stage pancreatic cancerous pain. Tumor Biol. 35, 2297–2301 (2014). https://doi.org/10.1007/s13277-013-1304-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13277-013-1304-z

Keywords

Navigation