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Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer Full Text
Journal of Clinical Oncology, 08/18/2011
Clinical Article
Wyse JM et al. – Early EUS–CPN reduces pain and may moderate morphine consumption in patients with painful, inoperable pancreatic adenocarcinoma. EUS–CPN can be considered in all such patients at the time of diagnostic and staging EUS.
Methods- Patients were eligible if referred for EUS for suspected pancreatic cancer with related pain
- If EUS and EUS–guided fine–needle aspiration cytology confirmed inoperable adenocarcinoma, patients were randomly assigned to early EUS–CPN or conventional pain management
- Pain scores (7–point Likert scale), morphine equivalent consumption, and QOL scores (Digestive Disease Questionnaire–15) assessed at 1 and 3 months
- 580 eligible patients were seen between April 2006 and December 2008
- 96 patients randomly assigned (48 patients per study arm)
- Pain relief was greater in EUS–CPN group at 1 month and significantly greater at 3 months (difference in mean percent change in pain score = –28.9 [95% CI, –67.0 to 2.8], P = .09, and –60.7 [95% CI, –86.6 to –25.5], P = .01, respectively)
- Morphine consumption was similar in both groups at 1 month (difference in mean change in morphine consumption = –1.0 [95% CI, –47.7 to 49.2], P = .99), but tended toward lower consumption at 3 months in neurolysis group (difference in mean change in morphine consumption = –49.5 [95% CI, –127.5 to 7.0], P = .10)
- No effect on QOL or survival
