Anaes Cases · Chronic & cancer pain
The pancreatic cancer pain
The long case — the pancreatic cancer pain. The mixed nociceptive-neuropathic-visceral pain, the celiac plexus block (the early interventional), the opioid rotation, the adjuvants (the neuropathic, the corticosteroid), the end-of-life care, and the palliative-care partnership.
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Prompt
A 64-year-old man with the metastatic pancreatic cancer has the severe epigastric pain radiating to the back, poorly controlled on the high-dose opioid. Discuss the multimodal management.
Presentation
A 64-year-old man with the metastatic pancreatic adenocarcinoma has the severe epigastric pain radiating to the back, worst at the night, partially relieved by the leaning forward. He is on the oral morphine 80 mg twice daily and the paracetamol, with the persistent pain (the score of 7 to 8 out of 10) and the opioid adverse effects (the sedation, the constipation, the nausea). Discuss the multimodal management.
[2]References3ShowHide
- [2]Blero D, et al. Pain management in pancreatic cancer: time to change our strategy. Curr Opin Oncol, 2026.PMID 42240215
- [4]Hagen KMR, et al. The PaSo paracetamol with strong opioids trial for cancer pain. BMJ Support Palliat Care, 2026.PMID 42309698
- [42309699]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.