Context Pancreatic cancer is an aggressive tumor associated with high mortality.
Optimal pain control may improve quality of life (QOL) for these patients.
Objective To test the hypothesis that neurolytic celiac plexus block (NCPB) vs
opioids alone improves pain relief, QOL, and survival in patients with unresectable
Design, Setting, and Patients Double-blind, randomized clinical trial conducted at Mayo Clinic, Rochester,
Minn. Enrolled (October 1997 and January 2001) were 100 eligible patients
with unresectable pancreatic cancer experiencing pain. Patients were followed
up for at least 1 year or until death.
Intervention Patients were randomly assigned to receive either NCPB or systemic analgesic
therapy alone with a sham injection. All patients could receive additional
opioids managed by a clinician blinded to the treatment assignment.
Main Outcome Measures Pain intensity (0-10 numerical rating scale), QOL, opioid consumption
and related adverse effects, and survival time were assessed weekly by a blinded
Results Mean (SD) baseline pain was 4.4 (1.7) for NCPB vs 4.1 (1.8) for opioids
alone. The first week after randomization, pain intensity and QOL scores were
improved (pain intensity, P≤.01 for both groups;
QOL, P<.001 for both groups), with a larger decrease
in pain for the NCPB group (P = .005). From repeated
measures analysis, pain was also lower for NCPB over time (P = .01). However, opioid consumption (P =
.93), frequency of opioid adverse effects (all P>.10),
and QOL (P = .46) were not significantly different
between groups. In the first 6 weeks, fewer NCPB patients reported moderate
or severe pain (pain intensity rating of ≥5/10) vs opioid-only patients
(14% vs 40%, P = .005). At 1 year, 16% of NCPB patients
and 6% of opioid-only patients were alive. However, survival did not differ
significantly between groups (P = .26, proportional
Conclusion Although NCPB improves pain relief in patients with pancreatic cancer
vs optimized systemic analgesic therapy alone, it does not affect QOL or survival.