title: Pain affecting procedures in non-resectable pancreatic carcinoma.
abstract: Pancreatic cancer is third most common cancer of the gastrointestinal tract in Bulgaria, accouting for 11, 6% in 2008. The leading symptom in patients with pancreatic cancer is the pain. The pain can be related with neoplasms and their metastasis. We should use all kind of resourses for pain relief: conventional drugs (according to the three steps strategy of WHO), interventional or surgical procedures.
  
  
  OBJECTIVE
  To present the interventional and surgical techniques in our practice and to share our experience for pain control in patients with nonresectable pancreatic cancer to improve their quality of life.
  
  
  METHODS
  In a seven year period (2004-2011) we performed 59 thoracoscopic splanhnicectomies/30--bilateral/ 4 intraoperative resections of celiac ganglion, 25 CT--control celiac plexus neurolysis and 90 cases pain relief with epidural analgesia. Concerning the quality of life we applied a questionnaire of a spannish medical center " City of Hope" adapted for patients with cancer and the level of pain with visual analogue scale VAS.
  
  
  RESULTS
  The long-term duration of the pain relief technique depends on applied technic, of cancer invasion and of the technic itself. The technique with the longest effect are the intraoperative celiac ganglion removal and the bilateral thoracoscopic splanhnicectomy. On the other hand the shortest effect we report the celiac plexus neurolysis, and the epudural analgesia. These data are in correlation with the reduction of the pain shown using VAS thus improving the quality of life.
  
  
  CONCLUSIONS
  The surgical and interventional methods for control of cancer pain have their own collocation improving the quality of life of these patients. New strategies for the pain control are need in the future.
authors.affiliation: Second Department of Surgery, UMHAT Saint Marina, Varna, Bulgaria. iplachkov@mail.bg
authors.forename: I
authors.initials: I
authors.lastname: Plachkov
authors.forename: P
authors.initials: P
authors.lastname: Chernopolski
authors.forename: V
authors.initials: V
authors.lastname: Bozhkov
authors.forename: R
authors.initials: R
authors.lastname: Madjov
mesh_terms: D015360:Analgesia, Epidural; D002031:Bulgaria / Q000453:epidemiology; D005728:Ganglia, Sympathetic / Q000601:surgery; D006801:Humans; D010146:Pain / Q000209:etiology* / Q000601:surgery*; D059408:Pain Management / Q000379:methods; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D011788:Quality of Life; D013153:Splanchnic Nerves / Q000601:surgery