Pain in pancreatic cancer: review of medical and surgical remedies.
Pancreatic cancer is a malignant tumour with very poor prognosis and a chance for 5-year survival is approximately 6%. One of the main symptoms of this neoplasm is pain, mostly of neuropathic origin, which significantly decreases the quality of life and impairs the functional activity of patients. The most common treatment of pain in pancreatic cancer is conservative therapy which is based on analgesic ladder rules established by the World Health Organization. Unfortunately, it is not always effective and it has many side effects that also can diminish patients' quality of life. Invasive treatment of pain in pancreatic cancer includes mainly coeliac plexus block and sympathectomy, and both of them significantly reduce levels of pain and help to improve the quality of life. It is postulated that the place of those two invasive methods should not be at the final stage of treatment, but they can provide significantly better improvement of pain once instituted earlier (such as the first or second step of analgesic World Health Organization's ladder). The aim of this article is to review and assess the conservative as well as the invasive therapy in the management of pain in pancreatic cancer. It also presents brief insight into non-medical methods of pain reduction, which can be supplementary to conservative and/or invasive treatment.
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland. lukaszdobosz@gumed.edu.pl.
Łukasz
Ł
Dobosz
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
Maciej
M
Kaczor
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
Tomasz J
TJ
Stefaniak
D000700:Analgesics / Q000627:therapeutic use; D002447:Celiac Plexus / Q000601:surgery; D003131:Combined Modality Therapy; D000529:Complementary Therapies; D006801:Humans; D009407:Nerve Block; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications*; D013562:Sympathectomy
D000700:Analgesics
invasive pain treatment; pain; pancreatic cancer; splanchnicectomy