Results of interventions on the celiac plexus in treating patients with chronic pharmacoresistant abdominal pain

Abstract

Patients with chronic abdominal pain are a complex cohort of patients who undergo treatment by many specialists for a long time: surgeons, urologists, gynecologists, neurologists, psychiatrists, etc. However, despite all diagnostic and treatment measures, the pain syndrome persists or worsens.

Objective ‒ evaluation of the effectiveness, safety and long-term results of treating patients with abdominal pain syndromes, which includes the use of various methods of minimally invasive interventions on the celiac plexus (CP) taking into account the peculiarities of the origin, nature and localization of pain.

Materials and methods. An analysis of the results of 26 interventions on CP in 21 patients was performed. Inclusion criteria for participants in the study were individuals with persistent pharmacoresistant abdominal pain for ≥3 months, aged 19 to 73 years. There were 13 (62.0%) male and 8 (38.0%) were female. Mean age was 55.2±15.2 years. Patients were divided into two groups. The first (n=16) included patients with pancreatic cancer, the second (n=5) included patients with non-oncological chronic abdominal pain syndromes: functional abdominal pain syndrome was diagnosed in three cases, and one observation each of solaritis and chronic pancreatitis.

All procedures were performed under CT. To assess the intensity of the pain syndrome, a visual analogue scale (VAS) of pain from 1 to 10 cm was used, where 0 cm is the absence of pain, 10 cm is unbearable pain; functional status (FS) - according to the Karnofsky scale (KS) from 0 to 100%. Estimation of the daily dose of opioid analgesics was estimated using the oral morphine equivalent daily dose (oMEDD). Patients were observed for 6 months, evaluations were carried out after 1 week, 1, 3 and 6 months, respectively.

Results. In the first group, 17 interventions on CP were performed in 16 participants, sympatholysis was performed twice in one patient. In the second group - 9 interventions in 5 patients: 4 Celiac Plexus Blocks (CPBs) of the central nervous system using "Depo-Medrol®" (methylprednisolone) and 5 neurolysis with 96% ethyl alcohol. Two patients were initially treated with CPB and then sympatholysis due to the recurrence of pain syndrome with the aim of a more stable sympatholytic and analgesic effect. In one patient, neurolysis of CP was performed three times. In all cases, no complications were recorded during the procedures.

VAS before the procedure in the general group (n=26) was 9.6±0.6 cm, one week after the intervention it was 4.5±1.6 cm (P<0.0001), after one month it was 3.2±1 .5 cm (P<0.0001), after 3 months – 3.0±1.6 cm (P<0.0001), after six months – 4.4±1.6 cm (P<0.0001). The FS indicator according to the KS before the procedure in the general group was 65.8±7.0%, one week after the intervention – 80.8±8.0% (P<0.0001), one month later – 81.5±8.3 % (P<0.0001), after 3 months – 75.0±9.5% (P<0.0010), after six months – 68.0±9.4% (P=0.4042). The oral morphine equivalent daily dose before the procedure in the general group was 123.8±86.0 mg per day, one week after the intervention on CP oMEDD was 57.3±61.2 mg (P<0.0001), after 1 month – 41.0±47.3 mg (P<0.0001), after 3 months – 44.0±51.3 mg (P<0.0001), after 6 months – 80.6±77.2 mg (P<0,0001).

Conclusions. Computed tomography-guided celiac plexus neurolysis is a useful and effective tool in treating patients with both abdominal pain caused by inoperable pancreatic cancer and chronic non-oncological pharmacoresistant abdominal pain. Minimally invasive interventions on CP provide a significant reduction of pain syndrome according to the VAS scale (p<0.001), reduce the need to take opioids analgesics (p<0.001) after 1, 3, 6 months and increase the FS of patients according to the KS (p<0.001) after 1, 3 months. Taking into account the high percentage of recurrence of pain syndrome in the studied patients of the group of non-oncology pain, the need for repeated interventions for the purpose of long-term pain control, interventions on CP in this cohort of patients require further research with an increase in the number of observations.