Pain in pancreatic cancer: review of medical and surgical remedies

Abstract

Pancreatic cancer is a malignant tumour with very poor prognosis and a chance for 5-year survival is approximately 6%. One of the main symptoms of this neoplasm is pain, mostly of neuropathic origin, which significantly decreases the quality of life and impairs the functional activity of patients. The most common treatment of pain in pancreatic cancer is conservative therapy which is based on analgesic ladder rules established by the World Health Organization. Unfortunately, it is not always effective and it has many side effects that also can diminish patients' quality of life. Invasive treatment of pain in pancreatic cancer includes mainly coeliac plexus block and sympathectomy, and both of them significantly reduce levels of pain and help to improve the quality of life. It is postulated that the place of those two invasive methods should not be at the final stage of treatment, but they can provide significantly better improvement of pain once instituted earlier (such as the first or second step of analgesic World Health Organization's ladder). The aim of this article is to review and assess the conservative as well as the invasive therapy in the management of pain in pancreatic cancer. It also presents brief insight into non-medical methods of pain reduction, which can be supplementary to conservative and/or invasive treatment.

Contemporary concepts of pain surgery

“…Sympathectomy and related procedures (splanchni-cectomy, celiac plexus block) appear to have a potential role in reducing visceral pain, primarily from pancreatic cancer. 4,10,25,28,71 A recent Cochrane analysis of the use of cervicothoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome (CRPS) concluded that the existing data are insufficient to support a recommendation with regard to sympathectomy for these pain conditions. 104 There is essentially no modern neurosurgical literature on this topic, and procedures that appear to be effective are generally performed either by anesthesiologists (celiac plexus block), or either thoracic or general surgeons (splanchnicectomy, sympathectomy).…”

Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain

“…[13][14][15] The resulting pain has both nociceptive and neuropathic components which complicates management, especially as most patients are not surgical candidates at presentation. 16 Direct intervention at the level of the celiac plexus acts downstream of the pain generators to disrupt the transmission of the pain signal regardless of signal type, and is therefore effective in simultaneously treating both types of pain.…”

Efficiency and safety of opioid therapy of chronic pain syndrome in patients with cancer of the refractory iron: clinico-pathogenetic features

“…Фентанил ТТС, n=22 [2]. Несмотря на наличие гендерных различий у пациентов IIА и IV стадий отсутствовали статистически достоверные различия по уровню интенсивности болевого синдрома, что может объясняться влиянием также других факторов, что требует дальнейшего изучения [3]. Снижение интенсивности боли в группах наблюдения в динамике сопряжено с высокобальными значениями по шкале ESAS в группе приема трамадола, что может объясняться наличием НЯ, влияющих на качество жизни [7].…”

“…Учитывая высокую заболеваемость и смертность, позднюю диагностику и преобладание агрессивных гистологических вариантов с низкой резектабельностью и отсутствием должной эффективности современных видов терапии, пациенты с раком поджелудоч-ной железы (РПЖ) также нуждаются в проведении паллиативной терапии на определенной стадии онкологического континуума [2]. Купирование болевого синдрома, как правило, является основной составляющей паллиативной терапии [3]. Изучение клинико -эпидемиологических особенностей ХБС на региональном уровне у пациентов с РПЖ является основой формирования персонализированной дорожной карты анальгетической терапии в условиях морфо -функциональных изменений желудочно -кишечного тракта на фоне ЗНО.…”