title: Comparative study between 2 protocols for management of severe pain in patients with unresectable pancreatic cancer: one-year follow-up.
abstract: BACKGROUND
  The efficacy of a celiac plexus block for the treatment of upper abdominal cancer-related pain has been documented. However, the effect of preprocedural pharmacological control of pain on its efficacy remains unknown. The researchers investigated the effect of first controlling severe pain with medications and then performing the celiac plexus block and compared the results with those obtained when the celiac block was performed first followed by pharmacotherapy for controlling severe pain; the impact on and duration of pain relief, effect on the quality of life, and analgesic requirements were analyzed.
  
  
  METHODS
  Sixty patients with nonresectable pancreatic cancer reporting visual analog scale (VAS) ≥ 70 (visceral pain, continuous or intermittent) were randomized into 2 equal groups. Group I comprised patients in whom the celiac block was performed early after the first meeting and then analgesic requirements were managed according to the severity of pain and the World Health Organization analgesic ladder. Group II comprised patients in whom analgesics were first given to control pain and the celiac plexus block was performed only when the patients reported a VAS score < 40. VAS and total daily analgesic consumption were recorded before the block, followed by weekly for 1 month, monthly for 6 months, and finally in the 9th and 12th months. Patient satisfaction was assessed using a quality of life questionnaire (QLQ-C30). Patients were asked to report any side effects particularly related to the procedure and intake of opioids.
  
  
  RESULTS
  Pain scores were comparable in both groups at initial assessment. However, in group II, VAS was reduced to 29.2 ± 4.48 in 8 ± 3 days through medical treatment before performing the block. At all time periods examined, pain scores were significantly lower in both groups compared with pretreatment scores (P < 0.0001). There was a significant decrease in VAS in group II when compared with group I at 2 months after the procedure and thereafter (P < 0.0001). Morphine sulfate consumption and frequency of opioid adverse effects were significantly lower in group II from the second month onward (P < 0.0001). The number of patients who showed good response to tramadol was significantly higher in group II in the second month until the 6th month (P < 0.05). QLQ-C30 was significantly lower in group II compared with group I from the 2nd month onward (P < 0.0001).
  
  
  CONCLUSIONS
  Controlling severe pain with medication and then performing the celiac block seems to be more effective in controlling pain, reducing opioid consumption, and improving the quality of life of patients with pancreatic cancer compared with performing the celiac block at the beginning followed by pharmacotherapy for pain relief.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Tanta University Hospital, Tanta University, Tanta, Egypt. yasser.amr@gmail.com
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Amr
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Makharita
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000379:methods; D002447:Celiac Plexus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D014147:Tramadol / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D014147:Tramadol