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A Randomized Controlled Trial

Gilbert Y. Wong, MD; Darrell R. Schroeder, MS; Paul E. Carns, MD; Jack L. Wilson, MD; David P. Martin, MD, PhD; Michelle O. Kinney, MD; Carlos B. Mantilla, MD, PhD; David O. Warner, MD

JAMA. 2004;291:1092-1099.

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 pancreatic cancer.

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 observer.

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 hazards regression).

Conclusion  Although NCPB improves pain relief in patients with pancreatic cancer vs optimized systemic analgesic therapy alone, it does not affect QOL or survival.

Author Affiliations: Department of Anesthesiology and Division of Pain Medicine, Mayo Clinic College of Medicine (Drs Wong, Carns, Wilson, Martin, Kinney, Mantilla, and Warner) and Department of Health Sciences Research, Mayo Clinic (Mr Schroeder), Rochester, Minn.

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