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HIV and AIDS Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Maurice Policar, Vasanthi Arumugam
In HIV, cholangitis is usually associated with opportunistic infection, malignancy, or immunologic destruction of the biliary epithelium. Manifestations include sclerosing cholangitis and/or papillary stenosis. Cryptosporidium and CMV are the most commonly identified associated infections. The clinical presentation is similar to that of cholecystitis. The alkaline phosphatase is usually markedly elevated, with minimally elevated transaminases and bilirubin, and a CD4 count <100. Ultrasound or CT will usually show dilated biliary ducts. Evaluation with endoscopic retrograde cholangiopancreatography (ERCP) is indicated, during which biopsy and bile cultures may be obtained. Stents can be placed to relieve obstruction from strictures, and sphincterotomy may help treat pain in some cases (Slaven et al., 2003). Celiac plexus neurolysis should be considered in patients with refractory pain (Collazos et al., 1996). Antimicrobial therapy is indicated when an infection is identified.
Pharmacotherapeutic options for pancreatic ductal adenocarcinoma
Published in Expert Opinion on Pharmacotherapy, 2022
Muhammad Sardar, Alejandro Recio-Boiles, Kabir Mody, Christian Karime, Sreenivasa R Chandana, Daruka Mahadevan, Jason Starr, Jeremy Jones, Mitesh Borad, Hani Babiker
Pain is common in advanced pancreatic cancer patients and should be addressed aggressively [94]. Celiac plexus neurolysis could be effective in select patients as pain could be primarily related to tumors proximity to the celiac plexus [95]. Obstructive jaundice is also common in patients with pancreatic head tumors and can be relieved by endoscopic placement of stents [96]. Metal stents are less likely to occlude as compared to plastic stents (median duration of patency 8–12 vs 2–5 months), however, they are more expensive and difficult to remove [97,98]. Pancreatic cancer patients can also develop gastric outlet obstruction and options include endoscopically placed expandable metal stents or palliative gastrojejunostomy [99,100]. Painful bone lesions or bleeding can be treated with palliative RT.
Feasibility study of MR-guided pancreas ablation using high-intensity focused ultrasound in a healthy swine model
Published in International Journal of Hyperthermia, 2020
Lukas Christian Sebeke, Pia Rademann, Alexandra Claudia Maul, Claudia Schubert-Quecke, Thorsten Annecke, Sin Yuin Yeo, Juan Daniel Castillo-Gómez, Patrick Schmidt, Holger Grüll, Edwin Heijman
Despite its moderately low incidence, pancreatic cancer (PaC) caused 4.5% of all cancer fatalities worldwide in 2018, making it the seventh most likely cause of cancer-related deaths [1]. PaC exhibits the lowest 5-year relative survival rate of any cancer [2]. This stems from a confluence of unfavorable characteristics, namely the late onset of symptoms, rapid involvement of the adjacent arteries, early development of metastases, and the ineffectiveness of systemic therapy [3–6]. As a result, resection is often impossible at time of diagnosis, leaving patients with limited therapeutic options, such as palliative chemotherapy [7]. The growing tumor mass often leads to complications, including duodenal- or biliary obstruction that requires the placement of stents or surgical intervention [7,8]. Furthermore, the pressure exerted on the surrounding nerves often induces abdominal and back pain, which is currently treated according to the WHO guidelines recommending a combination of analgesics escalating from nonopioids to strong opioids and adjuvant treatments [9,10]. In case the pain cannot be alleviated in this manner, celiac plexus block (CPB) and celiac plexus neurolysis (CPN) is applied [7]. However, the effectiveness of these techniques has been questioned and has not shown a significant benefit in quality of life over a placebo in a double-blinded randomized control trial [11]. Thus, patients diagnosed with advanced PaC are in urgent need of alternative treatment options and effective analgesia free of debilitating side-effects. Thermal ablation of PaC using high-intensity focused ultrasound (HIFU) offers a noninvasive method for tumor debulking and pain reduction and has therefore been explored in several clinical studies since the beginning of the century [12–21].
EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients – a meta-analysis and systematic review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abuzar A. Asif, Saqib K. Walayat, Matthew L. Bechtold, Vakya Revanur, Srinivas R. Puli
First reported in 1914 as an intraoperative procedure, celiac plexus neurolysis has proved to be an alternative or adjunctive intervention for pain management. Traditionally, CPN has been performed under fluoroscopic, ultrasonographic or computed tomography imaging guidance [3]. In 1996, a relatively safer, accurate and convenient technique was introduced by Faigal et al. and Wiersema and Wiersema, in the form of endoscopic ultrasonography guided celiac plexus neurolysis (EUS-CPN) [4,5]. Utilizing real-time imaging and Doppler assessment of intervening blood vessels provides the EUS-guided CPN an edge over other techniques [3].