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      The Role of Double Modality Ultrasonographic and Fluoroscopic Guided Superior Hypogastric Plexus Neurolysis in Treating Intractable Pelvic Cancer Pain: A Comparative Study

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          Superior hypogastric neurolytic block is performed to block visceral pelvic pain. This could be performed through the anterior approach guided by CT or ultrasound and through a posterior approach, guided by fluoroscopy or CT.


          Sixty adult patients with severe visceral pelvic pain (VAS>70 mm) were randomly divided into two groups. Group S: SHP block was done ultrasound guided using the anterior approach and confirmed by fluoroscopy. Group F: SHP block was done fluoroscopic guided using the posterior oblique approach. The VAS (visual analog scale), duration of the technique, time of X-ray exposure, patient satisfaction score, patient global impression of change (PGIC), quality of life score, and daily morphine consumption (mg/day) were measured pre-procedure and at the 1st, 4th, 8th, and 12th week after the procedure. In addition, any side effects of the procedure were recorded.


          There was a significant difference in VAS between the two groups ( P<0.01) (better in group S). The quality of life score was improved from the pre-procedure in both groups ( P<0.05), and morphine consumption was significantly lower in group S than in group F ( P<0.05) at the 1st, 4th, and 8th week and not significant at the 12th week. The two groups show a statistically significant difference as regards the duration of the procedure and X-ray exposure ( P<0.01). There was a statistically significant difference in the satisfactory score between the two groups at the 1st, 4th, 8th, and 12th week ( P<0.01). As regards the PGIC score, there was no statistically significant difference between the two groups ( P>0.05). In group S, no back pain was reported, while 11 patients of group F complained from post-procedure back pain ( P<0.001).


          The anterior ultrasound guided SHPB aided by fluoroscopy is suggested to be more superior to the standard fluoroscopic guided technique in relieving pelvic cancer pain and decreasing morphine consumption.

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          Most cited references 17

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          Pain and its treatment in outpatients with metastatic cancer.

          Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status. Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percent (475 of 1308) had pain severe enough to impair their ability to function. Forty-two percent of those with pain (250 of the 597 patients for whom we had complete information) were not given adequate analgesic therapy. Patients seen at centers that treated predominantly minorities were three times more likely than those treated elsewhere to have inadequate pain management. A discrepancy between patient and physician in judging the severity of the patient's pain was predictive of inadequate pain management (odds ratio, 2.3). Other factors that predicted inadequate pain management included pain that physicians did not attribute to cancer (odds ratio, 1.9), better performance status (odds ratio, 1.8), age of 70 years or older (odds ratio, 2.4), and female sex (odds ratio, 1.5). Patients with less adequate analgesia reported less pain relief and greater pain-related impairment of function. Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.
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            Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations.

            A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT for 4 core chronic pain outcome domains: (1) Pain intensity, assessed by a 0 to 10 numerical rating scale; (2) physical functioning, assessed by the Multidimensional Pain Inventory and Brief Pain Inventory interference scales; (3) emotional functioning, assessed by the Beck Depression Inventory and Profile of Mood States; and (4) participant ratings of overall improvement, assessed by the Patient Global Impression of Change scale. It is recommended that 2 or more different methods be used to evaluate the clinical importance of improvement or worsening for chronic pain clinical trial outcome measures. Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed. Systematically collecting and reporting the recommended information needed to evaluate the clinical importance of treatment outcomes of chronic pain clinical trials will allow additional validation of proposed benchmarks and provide more meaningful comparisons of chronic pain treatments.
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              Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain.

              Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block (CPB) on pain relief and quality of life (QOL), compared to the traditional NSAID-morphine treatment. The criteria were morphine consumption, visual analogue pain scale (VAS), performance status (PS) determined by medical and nursing staffs, and answers to QOL questionnaires. Morphine consumption, VAS, PS, and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control. Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter. CPB was performed within 2-3 days after the control measurement. The VAS scores of the patients receiving CPB (n = 10) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the standard NSAID-morphine treatment (n = 11) during the same time period after the control measurement. Morphine consumption was significantly lower in weeks 4-7 (inclusive) following the procedure in the CPB group and continued to be lower thereafter, though not significantly so. Although the PS score slightly improved at the 2nd week after CPB, it was not improved by the start of the NSAID-morphine treatment. Self-assessed QOL scores did not ameliorate statistically after CPB; however, they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods, while they deteriorated only slightly in the CPB group. There were fewer side effects after CPB. These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain, but it may prevent deterioration in QOL by the long-lasting analgesic effect, limitation of side effects and the reduction of morphine consumption, compared to treatment only with NSAID-morphine.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                27 May 2021
                : 14
                : 1465-1473
                [1 ]Department of Anesthesia, ICU And Pain Relief, National Cancer Institute, Cairo University , Cairo, Egypt
                [2 ]Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University , Assiut, Egypt
                [3 ]Department of Anesthesia, Critical Care and Pain Management, Faculty of Medicine, Cairo University , Cairo, Egypt
                [4 ]Department of Research on Children with Special Needs, National Research Center , Cairo, Egypt
                [5 ]Department of Diagnostic & Interventional Radiology, Faculty of Medicine, Cairo University , Cairo, Egypt
                Author notes
                Correspondence: Ehab H Shaker Department of Anesthesia and Pain Relief, National Cancer Institute, Cairo University , Cairo, EgyptTel +2-01222438820 Email ehabhanafy2006@yahoo.com
                © 2021 Abdelghafar 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. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 6, Tables: 8, References: 17, Pages: 9
                Original Research

                Anesthesiology & Pain management

                ultrasound, superior hypogastric block, fluoroscopy, pelvic pain


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