title: New aspects in performing interventional techniques for chronic pain.
abstract: OBJECTIVE
  We will evaluate the usefulness of the new intrathecal analgesic ziconotide in palliative care medicine. We will also examine the place and efficacy of neurolytic celiac plexus blockade in patients suffering from malignancy in the upper abdomen, after introducing better localization methods of the celiac plexus.
  
  
  RESULTS
  The analgesic effects of intrathecally administered ziconotide have been studied in patients suffering from pain due to AIDS or cancer. The results show a moderate to complete pain relief, significantly better than in placebo groups. However, safety studies show a high incidence of side effects. The technique of neurolytic celiac plexus blocks is refined by endoscopic ultrasound techniques.
  
  
  CONCLUSIONS
  The place of ziconotide in palliative care is doubtful due to unpredictable and sometimes long-lasting side effects. Real evidence on the efficacy and duration of neurolytic celiac plexus blocks for relief of pancreatic cancer pain is still not available. Future studies will need to be performed applying validated measurement instruments and assessing the patient's impression of the procedure's demands in terms of physical and mental tolerance.
authors.affiliation: aHospice Kuria, Amsterdam, The Netherlands bDepartment of Anesthesiology, VU Medical Center, The Netherlands. wwa.zuurmond@VUMC.nl
authors.forename: Wouter W A
authors.initials: WW
authors.lastname: Zuurmond
authors.forename: Roberto S G M
authors.initials: RS
authors.lastname: Perez
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Loer
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001340:Autonomic Nerve Block; D002447:Celiac Plexus; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006801:Humans; D007278:Injections, Spinal; D010146:Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods; D020960:omega-Conotoxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018712:Analgesics, Non-Narcotic; D020960:omega-Conotoxins; C078452:ziconotide