FPIN's Help Desk Answers

Nerve Blocks for Pancreatic Cancer Pain

 

Am Fam Physician. 2021 Apr 15;103(8):502.

Author disclosure: No relevant financial affiliations.

Clinical Question

Do nerve blocks control pancreatic cancer pain?

Evidence-Based Answer

Celiac plexus blocks can be used for pain associated with pancreatic cancer. They slightly reduce pain while decreasing opioid consumption, with fewer adverse effects compared with standard analgesic therapy. (Strength of Recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs].) Celiac plexus neurolysis is not well studied, but it appears to provide temporary pain relief for many patients with end-stage pancreatic cancer. (SOR: C, based on a case series.)

Evidence Summary

A 2011 systematic review of six RCTs (N = 358) evaluated the effectiveness and safety profile of celiac plexus blocks for pancreatic cancer pain.1 Fifty-six percent of participants were male. They were a mean age of 61 years, had any stage of unresectable pancreatic cancer, and were followed for at least four weeks postinjection. Participants were randomized to receive celiac plexus block (n = 176) or standard analgesic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) or morphine (n = 182). Celiac plexus block is a transient interruption of the nerve plexus via injection of an anesthetic. Pain levels were measured at four and eight weeks via a visual analog scale of 0 to 10, with higher numbers representing increased pain. Secondary outcomes that were analyzed included opioid consumption and adverse effects of the treatments. The celiac plexus block group had significantly lower pain at four weeks (four RCTs; n = 173; mean difference [MD] = −0.43; 95% CI, −0.73 to −0.14) and at eight weeks (five RCTs; n = 261; MD = −0.44; 95% CI, −0.89 to −0.01) compared with the control groups. Additionally, the amount of opioids consumed daily (measured in mg) at four weeks posttreatment decreased substantially in the celiac plexus block group compared with the control groups (four RCTs; n = 120; MD = −51 mg; 95% CI, −82 mg to −19 mg). Constipation was much less prevalent in the

Address correspondence to Thomas Wenstrup, MD, at twenstrup@schsa.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


Copyright © Family Physicians Inquiries Network. Used with permission.

References

1. Arcidiacono PG, Calori G, Carrara S, et al. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev. 2011;(3):CD007519.

2. Edelstein MR, Gabriel RT, Elbich JD, et al. Pain outcomes in patients undergoing CT-guided celiac plexus neurolysis for intractable abdominal visceral pain. Am J Hosp Palliat Care. 2017;34(2):111–114.

Help Desk Answers provide answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

 

 

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