OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education Innovation

Pancreatic cancer often presents with severe abdominal pain and the majority of patients with advanced disease report significant and difficult-to-control pain. Pain associated with pancreatic cancer includes epigastric pain that radiates to the back. Spinal cord stimulation is unlikely to be effective in the management of pain caused by cancer of the pancreas. A spinal cord stimulator is a pain control technique of neuromodulation that involves implanted electrodes in the posterior epidural space with resultant electrical stimulation of these electrodes. Spinal cord stimulation is effective for pain relief of neuropathic pain rather than nociceptive pain. Pain from pancreatic cancer is most likely a nociceptive pain syndrome and a spinal cord stimulator would be least likely to provide adequate pain relief. There are several neuroablative procedures that may be effective in the management of pain in patients with advanced pancreatic cancer including peripheral neuronectomy, dorsal rhizotomy, anterolateral cordotomy, commissural myelotomy, and hypophysectomy. Opioids may provide significant control of pancreatic cancer pain, whether administered intrathecally, IV or orally, in addition to other adjunctive pain medications.