July 2014
J Pain Symptom Manage. 2014 May [Epub ahead of print]
Amr YM, Makharita MY.
This multicentre study assessed the effect of sympathectomy (celiac, splanchnic or superior hypogastric blocks) on cancer related visceral pain before or after opioid therapy. 109 patients with inoperable abdominal or pelvic cancer, with moderate visceral pain (40 to 70 on a 0-100 visual analogue scale) and taking non-opioid analgesics, were randomised to either sympathectomy before opioid therapy commencement or after the failure of strong opioids to control pain. It showed that those receiving early sympathectomy were significantly more likely to respond to therapy (with at least a 58% decrease in their visual analogue scale pain score); they also needed less opioids during first 12 months, as well as having less side effects. Global quality of life, physical, emotional and cognitive functioning were improved until at least month 5 in those receiving early sympathectomy. There was no difference in survival. This study indicates that there might be a role for early sympathectomy for cancer related abdominal or pelvic visceral pain.
Prepared by Jason Boland