Cancer Pain
Conditions
Brief summary
Pain is prevalent among patients with gastrointestinal cancers. Standard procedures such as coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases. Meanwhile, splanchnic nerve neurolysis (SNN) as an alternative to CPN is more effective for cancer pain relief. Although previous studies investigating the role of CPN/SNN mainly focus on pancreatic cancer cases, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.
Detailed description
Pain is prevalent among patients with gastrointestinal cancers. There is abundant evidence that coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases while the evidence for other upper abdominal cancer pain is less robust but emerging. Meanwhile, there is an increasing interest in utilising splanchnic nerve neurolysis (SNN) as an alternative to CPN for cancer pain relief. Although previous studies investigating the role of CPN/SNN involved heterogenous types of intra-abdominal malignancies, majority of cases were pancreatic cancer. Therefore, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.
Interventions
OTHERCoeliac plexus neurolysis
Coeliac plexus neurolysis (CPN) will be performed bilaterally. Neurolytic solution will be injected around the coeliac plexus (a network of nerves located in the abdomen).
OTHERSplanchnic nerve neurolysis
Splanchnic nerve neurolysis (SNN) will be performed bilaterally. Neurolytic solution will be injected around the splanchnic nerves (a nerve located at thoracic trunk).
Sponsors
The University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
The patients and independent investigators collecting outcome data will be blinded.
Intervention model description
The randomization sequence will be generated by Microsoft Excel software. Blocked randomization will be done with an allocation ratio of 1:1. This will be prepared by a statistician unaware of the nature of the clinical study. The sequence will be concealed in opaque envelopes and opened by an investigator just before the procedure. The patients and independent investigators collecting outcome data will be blinded
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age\>=18 * Diagnosis of unresectable intra-abdominal cancer * Visceral pain attributable to the cancer with NRS \>= 4 * Able to understand instructions, give consent, complete questionnaires
Exclusion criteria
* Primary pancreatic cancer or metastatic disease involving pancreas * Gross celiac axis distortion identified on imaging * Acute abdomen condition eg. Intraabdominal sepsis, tumor rupture * Other non-cancer causes attributable to the pain * Gross ascites * Previous coeliac plexus or splanchnic nerve neurolysis * Contraindications to neurolytic procedures eg. Bleeding tendency; local or systemic infections; allergic to local anesthetics, contrast or alcohol; intestinal obstruction; anatomical distortion along needle trajectory * Patients believed to be inappropriate for study by investigators
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pain score | at one week after procedure | Pain intensity using numerical rating scale from 0 to 10 where 0 is no pain and 10 is the worst pain. |
Countries
Hong Kong
Contacts
Primary ContactTimmy CW Chan, MBBS
Outcome results
None listed