Celiac Block Reduces Pain of Pancreatic Cancer

Laurie Barclay, MD

March 02, 2004

March 2, 2004 — Neurolytic celiac plexus block (NCPB) reduces pain for patients with pancreatic cancer but does not improve quality of life (QOL) or survival, according to the results of a randomized trial published in the March 3 issue of The Journal of the American Medical Association.

"Pancreatic cancer is an aggressive tumor associated with high mortality," writes Gilbert Y. Wong, MD, and colleagues from the Mayo Clinic in Rochester, Minnesota. "Optimal pain control may improve [QOL] for these patients."

From October 1997 through January 2001, 100 eligible patients with pain from unresectable pancreatic cancer were enrolled in this double-blind trial at the Mayo Clinic, randomized to receive either NCPB or systemic analgesic therapy alone with sham injection, and followed for at least one year or until death. All patients were allowed to receive additional opioids managed by a physician blinded to treatment group.

Mean baseline pain intensity on a 0 to 10 numerical rating scale was 4.4 ± 1.7 for the NCPB group and 4.1 ± 1.8 for the opioid group. After the first week of treatment, pain intensity and QOL scores improved from baseline in both groups (P < .01 for pain intensity and P <. 001 for QOL), but there was a larger decrease in pain for the NCPB group (P = .005 vs. opioid group). Repeated measures analysis revealed that pain was also lower for NCPB over time (P = .01). During the first six weeks of treatment, moderate or severe pain (intensity rating of greater than 5/10) occurred in 14% of the NCPB group and in 40% of the opioid-only group (P = .005).

Opioid consumption, frequency of opioid adverse effects, and QOL were all similar in both groups. One-year survival was 16% in the NCPB group and 6% in the opioid-only group, but survival was not significantly different between groups (P = .26 by proportional hazards regression).

"Although NCPB improves pain relief in patients with pancreatic cancer vs. optimized systemic analgesic therapy alone, it does not affect QOL or survival," the authors write. "The current investigation was designed to provide 90% power to detect a difference in survival, [but] the sample size for the current investigation may not provide adequate statistical power to make definitive conclusions regarding smaller differences in survival that still may be clinically relevant."

The Foundation for Anesthesia, Education, and Research (FAER) New Investigator Award, Martin Ehler's Program for Psychosocial Oncology and Spiritual Care at the Mayo Clinic Cancer Center, the Cancer Treatment Research Foundation, the May Anesthesiology Clinical Research Unit, and the Mayo Clinic and Foundation supported this study.

JAMA. 2004;291:1092-1099

Reviewed by Gary D. Vogin, MD

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