Superior Hypogastric Plexus Neurolysis May Help Some With Cancer-Related Pelvic Pain

By Reuters Staff

August 13, 2019

NEW YORK (Reuters Health) - Superior hypogastric plexus neurolysis (SHPN) appears to offer some relief for cancer-related pelvic pain, researchers report.

Pain arising from the pelvic organs can be interrupted by a neurolytic block of the superior hypogastric plexus with alcohol or phenol. Few studies have evaluated the effectiveness of this intervention.

To investigate, Dr. Dhanalakshmi Koyyalagunta and colleagues from MD Anderson Cancer Center, in Houston, Texas, examined data on 46 patients who received SHPN for pelvic cancer pain; the average follow-up duration at the first evaluation was 13.4 days.

At the first evaluation, 22 patients (48%) had experienced an improvement in pain, with mean pain scores decreasing from 6.9/10 at baseline to 5.6/10 at follow-up (P=0.006), the researchers report in Pain Medicine, online July 25.

This difference was smaller than the minimal clinically important difference of 2/10, but among patients with baseline pain scores of 7/10 or greater, the main pain score decreased by 2.7 points (from 8.2 to 5.5).

At the second evaluation, at an average of 53.9 days, including 30 patients, the mean pain score had decreased from 6.9/10 at baseline to 5.3/10 at the first evaluation to 4.5/10 (P<0.0001).

Factors associated with an improvement in pain score of 2/10 or greater included a baseline pain score of 7/10 or higher and nonsmoking status.

All of the adverse effects in this study were very mild and well tolerated.

"Our study results suggest that SHPN is an effective treatment for patients with cancer-related pelvic pain with minimal adverse effects," the researchers conclude. "Future studies are needed using prospective research designs, active control groups, large patient populations, standardized data collection, and longer follow-up."

The study had no external funding, and the researchers reported no conflicts of interest.

Dr. Koyyalagunta did not respond to a request for comments.


Pain Med 2019.