Gao, L., Yang, Y.J., Xu, H.Y., Zhou, J., Hong, H., Wang, Y.L., & Li, D.C. (2014). A randomized clinical trial of nerve block to manage end-stage pancreatic cancerous pain. Tumour, 35, 2297–2301. 

DOI Link

Study Purpose

To determine the effectiveness of nerve blocks to control pain in patients with end-stage pancreatic cancer pain

Intervention Characteristics/Basic Study Process

Patients were randomized to two groups, the sham and nerve block groups. Visual Analog Scale (VAS) pain scores, pain duration, reduction of other analgesics, and quality of life scores (measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) were obtained before and three months after intervention.

Sample Characteristics

  • N = 100  
  • MEAN AGE = 65.5 years
  • MALES: Unknown, FEMALES: Unknown 
  • KEY DISEASE CHARACTERISTICS: Unresectable or inoperable carcinoma of the pancreas by CT or EUS; stage determined by the 2010 American Joint Committee on Cancer (AJCC) manual; presence of midabdominal pain at a minimum of two days per week for at least one hour per day; INR 1.5; platelets greater than 50,000; life expectancy greater than three months
  • OTHER KEY SAMPLE CHARACTERISTICS: Age had to be greater than 18; excluded if unable to sign consent; excluded if patient had previous blocks; excluded if patient had chronic pancreatitis

Setting

  • SITE: Not stated/unknown    
  • SETTING TYPE: Not specified    
  • LOCATION: Not specified; approved by Soochow University Ethical Committee in China

Phase of Care and Clinical Applications

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Elder care, palliative care 

Study Design

Sham-controlled, randomized, controlled trial

Measurement Instruments/Methods

  • Visual Analog Scale (VAS)
  • European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)

Results

The neurolysis group (N) and sham group (S) did not demonstrate a difference in pain. At three months, group N had a significant (p < 0.05) improvement in pain. Pain duration decreased (14.6 ± 0.3 hours per day to 6.1 ± 0.2 hours per day; p < 0.05) in group N compared to group S before and after the intervention. Group S had no significant change. Reduction of other analgesic medication in groups N versus S was significant (p < 0.05), specifically for NSAIDs and oxycodone among others excluding morphine. At three months, quality of life (QL), function (physical and emotional), and symptoms scales improved in the N group versus the S group. Notably, appetite loss, symptoms scores, and insomnia improved the most.

Conclusions

This study presents a potential additional intervention in combination with pain medication in patients with end-stage pancreatic cancer-associated pain. Additional potential benefits could be the improvement of physical and emotional function, fatigue, insomnia, and loss of appetite. This study would have to be replicated with a larger sample size to prove efficacy.

Limitations

  • Findings not generalizable
  • Other limitations/explanation: Follow-up period was limited to three months; location of tumor was not identified; prior therapies not identified; less generalizable sample size 100

Nursing Implications

This type of therapy presents a potential intervention in combination with pain medication for pain control in end-stage pancreatic cancer based on this randomized, controlled trial. After-care of a patient with a nerve block would require training. An assessment of the adjustment of other medicinal treatments would be required at baseline in this intervention.