NEW YORK (Reuters Health) – In patients newly diagnosed inoperable pancreatic cancer, it’s worth considering celiac plexus neurolysis (CPN) for pain control at the same time that endoscopic ultrasound (EUS) is performed for diagnosis and staging purposes, conclude the authors of a report in the Journal of Clinical Oncology.

“Early EUS-CPN provides better pain relief and may prevent progressive increases in morphine consumption compared with conventional management,” Dr. Jonathan Wyse from University of Montreal, Quebec, Canada and colleagues write.

This is particularly true in patients who do not receive chemotherapy and/or radiation therapy (chemo-XRT), they’ve found.

Because EUS-CPN is safe and it’s often unclear which patients will receive or be able to tolerate chemo-XRT, they recommend early EUS-CPN “be considered during diagnostic and staging EUS in all patients with predicted survival of several months in whom confirmation of painful, locoregional, and inoperable pancreatic cancer is obtained.”

At diagnosis of pancreatic adenocarcinoma, fewer than 20% of patients are considered eligible for resection and only about 5% are still alive at 5 years.

CPN is currently used late in the disease process, as salvage therapy for morphine-resistant pancreatic cancer pain, Dr. Wyse and colleagues point out. But because EUS is used at the beginning of the diagnostic algorithm for pancreatic cancer, it provides an opportunity to perform EUS-CPN early (at the time of diagnosis).

EUS-CPN has an excellent safety profile, they note, and in recent a meta-analysis of EUS-CPN studies, pain reduction was observed in approximately 80% of patients.

To be eligible for the current study patients had to be referred for EUS for suspected pancreatic cancer with related pain. If EUS and EUS-guided fine-needle aspiration cytology confirmed inoperable adenocarcinoma, patients were randomly assigned to early EUS-CPN or conventional pain management (control arm). A total of 98 patients were eventually randomized; 49 to each arm.

The investigators report that early EUS-CPN was safe, with no early or late complications, and added only about 2 to 3 minutes to the diagnostic and staging EUS procedure.

In addition, at 1 and 3 months, there was a decrease in pain scores in the EUS-CPN arm and an increase in the control arm, relative to baseline. In the EUS-CPN arm, average pain scores decreased by 18% at 1 month and by 49% at 3 months.

Early EUS-CPN was “particularly effective” in relieving pain and stabilizing narcotic use in patients who did not undergo chemo-XRT, the authors note.

Both the control and EUS-CPN arms increased their morphine consumption relative to baseline at 1 month. However, while morphine leveled off in the CPN group, it continued to increase in the control group.

Despite better pain control, early EUS-CPN did not prolong survival or markedly improve quality of life, the authors say.

J Clin Oncol 2011;29.