Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-stage pancreatic abdominal cancer pain.

BACKGROUND: Pancreatic cancer pain is often severe and refractory to conservative therapies. Several interventional techniques have been described for the management of end-stage pancreatic cancer pain, with variable results and complications. OBJECTIVES: The aim of this study was to assess the efficacy of bilateral radiofrequency thermocoagulation of splanchnic nerves for pain relief, the consumption of opioids, and the quality of life in patients suffering from severe pain due to pancreatic malignancies. STUDY DESIGN: A retrospective observational design. SETTING: The study includes patients with end-stage pancreatic abdominal cancer pain, which is refractory to conservative treatment. METHODS: Thirty-five patients were studied. They were evaluated prior to and after the radiofrequency thermocoagulation of both splanchnic nerves under fluoroscopic guidance. The assessment included the pain intensity (Numeric Rating Scale 0 - 10), quality of life (self-reported quality of life score 0 - 10), and 24-hour consumption of opioids with monthly follow-up visits until the end of life. RESULTS: Follow-up was completed 6 months after the intervention. The pain scores, quality of life, and consumption of opioids were significantly improved during the entire follow-up period. A slight deterioration was noticed during the fifth month because of malignancy progression. No complications that could be attributed to the technique were observed. LIMITATIONS: The study was not prospective and does not have a control group with a different intervention for comparisons. CONCLUSION: Radiofrequency thermocoagulation of both splanchnic nerves may offer a safe and effective technique for pain management and quality of life improvement in patients with end-stage pancreatic cancer towards the end of life.