Problems in Cancer Pain: Pancreatic Cancer

By | September 27, 2011

One of the first things that we see with these patients, even with the placement of the epidural trial catheter is an improvement in their appetite.

We have talked about pancreatic cancer in the context of changing survival rates and treatment patterns.  I would like to discuss the role of advanced pain management techniques in the total care of the patient.  There is good data to show that patients who receive intrathecal pain therapy live longer than age and disease matched patients who don’t.  Nowhere is this seen more clearly than in advanced cancer of the pancreas.  While there are many factors that are likely to contribute to this increased survival, but I will focus on, nutritional balance as illustrative of all others.

There are many things about this disease that contribute to the poor nutritional state of most of the patients including the disease itself.  Once the disease spreads beyond the capsule of the gland, patients develop a characteristic band-like middle abdominal pain associated with nausea and loss of appetite.  Radiation therapy and chemotherapy both exacerbate the loss of appetite and finally the narcotics that are initially used to treat the pain have prominent appetite suppression side effects.

One of the first things that we see, even with the placement of the epidural trial catheter, is an improvement in their appetite.  This improvement in appetite is so dramatic that the first question that I ask these patients on return visits is how their appetite is.  A deteriorating appetite is often a harbinger of an increase in their chronic pain and visa versa.  It is not uncommon to see patients regain 5 or 10 pounds of lost weight after starting therapy.  It is my feeling that this improvement in metabolic status increases the patient’s chance of responding to radiation and chemotherapy.  This is a clearly an example of a win-win situation with improved quality of life added onto prolonged survival.

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