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      Celiac plexus block increases quality of life in patients with pancreatic cancer

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          Abstract

          Background

          Pancreatic cancer is a malignant disease with a high mortality rate and severe pain that is challenging to manage. To reduce the excruciating abdominal pain, opioids and adjuvant agents are conventionally used.

          Objectives

          PRNCPB is a treatment of neural therapy. The number of studies assessing the effect on patients’ QoL is limited and inconsistent. With this study, we intended to address this issue.

          Study design

          A prospective nonrandomized study with a series of cases of unresectable pancreatic cancer was conducted.

          Setting

          The study was performed at our pain clinic under real life conditions.

          Materials and methods

          A total number of 16 patients with severe abdominal pain were enrolled in the study all of whom had responded to combined systemic analgesic therapy inadequately and had intolerable side effects contraindicating further increase in dose. The efficacy of this invasive, palliative analgesic procedure was evaluated 35 days after PRNCPB was performed. Primary outcomes were changed in pain intensity using the VAS questionnaire. Secondary outcomes were improved in QoL using the SF-36 questionnaire. Changes in pain medications and adverse reactions were monitored.

          Results

          After PRNCPB patients experienced a significant decrease ( P=0.002) in pain intensity as shown by the VAS score, and a decreased opiate demand. Their QoL scores considering effect sizes also improved ( P<0.001). No complications attributable to PRNCPB were observed during the study period. Additionally, no adverse drug reactions were observed.

          Limitations

          Detection, observation, and reporting bias can be estimated as moderate. Selection bias was not detected.

          Conclusion

          Our results give preliminary evidence that PRNCPB might be helpful as an additional treatment to conventional pain management in end-stage pancreatic cancer patients. PRNCPB seems to improve QoL in these patients in a time frame of at least 5 weeks after intervention.

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          Most cited references 60

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          The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.

          The widespread use of standardized health surveys is predicated on the largely untested assumption that scales constructed from those surveys will satisfy minimum psychometric requirements across diverse population groups. Data from the Medical Outcomes Study (MOS) were used to evaluate data completeness and quality, test scaling assumptions, and estimate internal-consistency reliability for the eight scales constructed from the MOS SF-36 Health Survey. Analyses were conducted among 3,445 patients and were replicated across 24 subgroups differing in sociodemographic characteristics, diagnosis, and disease severity. For each scale, item-completion rates were high across all groups (88% to 95%), but tended to be somewhat lower among the elderly, those with less than a high school education, and those in poverty. On average, surveys were complete enough to compute scales scores for more than 96% of the sample. Across patient groups, all scales passed tests for item-internal consistency (97% passed) and item-discriminant validity (92% passed). Reliability coefficients ranged from a low of 0.65 to a high of 0.94 across scales (median = 0.85) and varied somewhat across patient subgroups. Floor effects were negligible except for the two role disability scales. Noteworthy ceiling effects were observed for both role disability scales and the social functioning scale. These findings support the use of the SF-36 survey across the diverse populations studied and identify population groups in which use of standardized health status measures may or may not be problematic.
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            The MOS short-form general health survey. Reliability and validity in a patient population.

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              Treatment of cancer pain.

               R Portenoy (2011)
              In patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family. This review describes this framework, an approach to pain assessment, and widely accepted techniques to optimise the safety and effectiveness of opioid drugs and other treatments. The advances of recent decades suggest a future that includes increased evidence-based targeting of specific analgesic interventions within an individualised plan of care that is appropriate throughout the course of illness. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2019
                14 January 2019
                : 12
                : 307-315
                Affiliations
                [1 ]Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary, henrik.szoke@ 123456etk.pte.hu
                [2 ]Department of CAM, Faculty of Health Sciences, University of Pécs, Pécs, Hungary, henrik.szoke@ 123456etk.pte.hu
                [3 ]Department of Nephrology, Fresenius Medical Care, Cegléd, Hungary
                [4 ]Department of Pediatrics, University of Vienna, Vienna, Austria
                [5 ]Pediatric Outpatient Department, Krems, Austria
                [6 ]University Children’s Hospital, University of Tuebingen, Tuebingen, Germany
                [7 ]Department of Complementary and Integrative Medicine, ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
                [8 ]Department of Psychiatry and Psychiatric Rehabilitation, Saint John Hospital, Budapest, Hungary
                [9 ]Department of Medical Clinics I, Klinikum Niederlausitz, Lauchhammer, Germany
                Author notes
                Correspondence: Henrik Szőke, Department of CAM, Faculty of Health Sciences, University of Pécs, Vasvári Pál utca 4., 7622 Pécs, Hungary, Email henrik.szoke@ 123456etk.pte.hu
                Article
                jpr-12-307
                10.2147/JPR.S186659
                6338112
                © 2019 Molnár et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

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