A Systematic Review of Interventions for Pain in Patients with Incurable Pancreatic Cancer

Abstract Objectives: Incurable pancreatic cancer poses challenging analgesic requirements, which subsequently affect the quality of life of patients. The aim of this review was to assess the available methods of managing pain in incurable pancreatic cancer, how these are utilized, and their effectiveness in patients. Data Sources: A comprehensive literature search was conducted of online databases, including Medline and Embase, using MeSH terms. The study was registered with PROSPERO number 1164775. Study Selection: Inclusion and exclusion criteria included patients >18 years and a sample size >40. This resulted in 9 papers being included in the study. Secondary outcomes included functional status, quality of life, anxiety, and depression. Results: The studies focused on various regional nerve blocks and oral analgesia. These used a numerical analogue scale as a self-reported outcome measure of pain. Results found that oral combination analgesia provided better analgesic effects than monotherapy. This was similarly found to have improved quality of life and psychological well-being. Eight studies found nerve blocks to be a more effective method of treating pain than oral analgesia alone. Conclusion: By using combination analgesics, studies found that reduced doses of opioids were required, thus reducing side effects. Celiac plexus blocks were found to be associated with lower opioid requirements and subsequently less side effects, particularly in the initial months following treatment. This demonstrates an important option in pain management for patients with complex pain in advanced pancreatic cancer.