Pain management of pancreatic cancer

Quality of life is receiving increasing attention as a criterion for the as sessment of treatment, not least for surgery, in pancreatic cancer. In exoc rine pancreatic cancer there are three main symptoms that must be dealt wit h: pain, loss of weight and jaundice. All of them seriously impair quality of life, but most often pain is the most feared by the patients. Despite th is, the intensity and the quality of the pain is all too often only scantly described. In 85 consecutive patients with newly diagnosed pancreatic cancer we have p rospectively registered the quality and quantity of their pain and correlat ed it to tumor and patient characteristics. It was found that about one fou rth of the patients were totally pain free and half of all suffered a pain decribed by two or less on a Visual Analogue Scale. Only one in ten had sev ere pain. Although more and more patients were treated with morphine, it wa s still about one third of all patients that had no or only little pain in the last part of their life. Pain had a strong correlation to survival. Thi s may be due to secondary effects like depressing the mood of the patient a nd reducing the food intake, but is probably more often a reflection of tha t generalized cancer induces more pain. Analgesic drugs are the cornerstone of the pharmacologic management of pain due to pancreatic cancer. A significant part of the patients do well with only paracetamol and nonsteroidal antiinflammatory agents. Combining these agents with narcotic analgesics can enhance pain control while lessening th e dose of narcotics. A wide range of narcotics are available as well as dif ferent modes for delivery: regular pills, slow release forms, injections, s ubcutaneous injections, epidurals etc. Each patient's pain management shoul d be individualized, based on the intensity of pain, the type of pain and t he side effects. It is essential not only to describe the medication, but a lso to follow-up the development of the pain and the patient's total experi ence of the situation. As an alternative to narcotics, plexus celiac blocks have been used with somewhat different result; in the hands of the experts the percutaneous approach is usually sufficient, but in the hands of other also poor results are reported. During the last years thoracoscopic splanc hnicectomy has been tried as a complement giving long-standing pain relief with little or no side effects in the majority of patients. With this appro ach the sympathic fibers lead by the symphathetic chain and further by the nervus splanchnicus major, minor and minoris are divided. The denervation i s easily done and can be performed bilaterly in one seance. This method wil l probably be used more often as the technique is now well described.